Fig. 1.—Titanic “Memorial,” by Mrs. Harry Payne Whitney. INDIVIDUAL GYMNASTICS 
A HANDBOOK OF CORRECTIVE AND 
REMEDIAL GYMNASTICS 
HY 
LILLIAN CURTIS DREW 
DIRECTOR OF DEPARTMENT OF CORRECTIVE GYMNASTICS, CENTRAL BRANCH 
Y. W. C. A., NEW YORK CITY; INSTRUCTOR IN CORRECTIVE AND REMEDIAL 
GYMNASTICS AND KINESIOLOGY, CENTRAL SCHOOL OF HYGIENE AND 
PHYSICAL EDUCATION AND NEW YORK UNIVERSITY, NEW YORK 
CITY, FORMERLY DIRECTOR OF DEPARTMENT OF CORREC- 
TIVE GYMNASTICS, TEACHERS’ COLLEGE, COLUMBIA 
UNIVERSITY, NEW YORK CITY; INSTRUCTOR IN 
CORRECTIVE GYMNASTICS UNDER THE 
DIRECTION OF DR. E. H. BRADFORD, 
BOSTON, AND DR. E. G. BRACKETT, 
BOSTON, MASS. 
SECOND EDITION, THOROUGHLY REVISED 
ILLUSTRATED WITH 109 ENGRAVINGS 
LEA & FEEIGER 
PHILADELPHIA AND NEW YORK 
1923 Copyright 
LEA & FEBIGER 
1923 
PRINTED IN U. S. A. PREFACE. 
The author’s experience in individual gymnastics has 
been such as to justify the belief that there exists at the 
present time the need of a book which shall clearly and 
correctly present, to those who are interested in physical 
education, the causes and treatment of certain physical 
defects. 
By reason of these physical abnormalities or of some 
inefficiency in the individuals under the supervision of 
teachers in this line of work, puzzling problems frequently 
arise which necessitate, or at least make advisable, cer- 
tain changes or modifications of the regular gymnastic 
lesson. The substitution in such cases of individual gym- 
nastics, or their use as an adjunct to work with the group 
in the gymnasium, has been a matter to which the author 
has given careful thought and exhaustive study. This 
book, based upon the experiences of many years, has been 
written for the purpose of meeting needs evident, in cases 
of the above character, by suggesting the most practical 
and helpful way of bringing about results in individual 
emergencies. 
The recognition of such conditions and the ability to 
deal with them intelligently are within the province of 
every teacher of physical education. 
The importance of these matters cannot be overesti- 
mated. iv 
PREFACE 
Abnormal conditions of most frequent occurrence are 
analyzed, their causes discussed and attention directed to 
lines of procedure for prevention and improvement. Con- 
siderable space has also been given to the description and 
application of exercises, the illustrations for which were 
drawn from life by Miss Margaret Robertson. 
The author sincerely hopes that this book will accomplish 
the purposes for which it is intended. It is submitted to 
those who have made work of this kind a study and practice; 
to all teachers and students of physical education, and also 
to others interested in the solution of the many difficult 
problems on which the writer has endeavored to shed some 
light in this short treatise. 
L. C. D. 
New York, 1923. FOREWORD. 
The role that is played by properly applied corrective 
and developmental gymnastic work is an important one in 
the hygiene of modern life, and particularly modern urban 
life. A book which calls attention to this form of therapy 
is particularly welcome, and especially so now, since during 
the past few years, emphasis has been necessarily placed 
on its closely associated ally, in the various forms of physio- 
therapy. The value of preventive and corrective physical 
aids in the developmental periods of youth, and the definite 
benefit which follows the employment of the corrective 
forms of exercise, in the strenuous life of the ordinary 
individual, place this feature of therapy, viz., individual 
gnmnastics in a forerank of importance. 
The author has indicated the proper relation which the 
gymnastic and the corrective exercises bear to the practice 
of medicine. The position is assumed that, as the applica- 
tion of all medical remedial agencies are a part of the practice 
of medicine, they should be under its general medical guid- 
ance. It is sometimes more practical, and it is frequently 
necessary, that the direction, and often the prescription, of 
gymnastic exercises should be under the guidance of the 
properly trained physical instructor, who must use his 
judgment and knowledge in the application of the remedial 
forces, in the use of which he is trained, in order to obtain 
a given end. For the help of such, the author has pre- VI 
FOREWORD 
sented practical and safe advice and has marked out the 
right course to follow in these somewhat troublous waters. 
The student in this department of work can be guided in 
a course which will allow initiative in his own special depart- 
ment of therapy, and yet keep in touch with the medical 
profession, for the necessary knowledge and direction that 
is necessary to treat pathological conditions. 
The author has been able to bring to this work a rather 
unusual and varied knowledge, obtained on the one hand, 
from the experience of personal contact with a very large 
number of individuals, and on the other hand, from the 
experience of a contact with large groups, both in treating 
and in teaching, and in consequence has learned to know 
what is most needed by students of this form of therapy, 
and how to best present it to them. The importance of 
this feature cannot be overemphasized, for in this field so 
closely allied to the practice of medicine, the preservation 
of the personal element is most important, in order to obtain 
cooperation and the best results. The material in this work 
has been particularly well divided, and the subjects so pre- 
sented as to facilitate the study of each one as desired. 
E. G. Brackett, 
Boston. CONTENTS. 
CHAPTER I. 
Individual Gymnastics: its Place in Physical Education. 
Conditions for which it is Advisable 17 
CHAPTER II. 
Equipment. Application of Individual Gymnastics. Gen- 
eral Directions. Plan of Exercise Program. Teacher’s 
Responsibility. Psychology of Individual Gymnastics 22 
CHAPTER III. 
Anatomy of the Human Body. Planes of the Body. Physio- 
logical Curves. Inclination of the Pelvis. Movements 
of the Spine 33 
CHAPTER IV. 
The Upright Posture. Values of Posture 43 
CHAPTER V. 
Antero-posterior Faulty Postures 53 
CHAPTER VI. 
Examination—Records—The Schematograph—Treatment— 
Posture Drives—Posters 77 
VII VIII 
CONTENTS 
CHAPTER VII. 
Exercises for the Correction of Faulty Antero-posterior 
Posture 97 
CHAPTER VIII. 
Corrective Exercises for Groups 129 
CHAPTER IX. 
Visceroptosis 135 
CHAPTER X. 
Scoliosis . . 141 
CHAPTER XL 
The Feet 191 
CHAPTER XII. 
Shoes—Exercises for the Feet 210 
CHAPTER XIII. 
Infantile Paralysis 225 
CHAPTER XIV. 
Constipation—Dysmenorrhea 232 
CHAPTER XV. 
Overweight and Underweight 245 
CHAPTER XVI. 
Indications for Exercise in Abnormal Heart and Thyroid 
Conditions 251 INDIVIDUAL GYMNASTICS. 
CHAPTER I. 
INDIVIDUAL GYMNASTICS: ITS PLACE IN PHYSI- 
CAL EDUCATION. CONDITIONS FOR WHICH 
IT IS ADVISABLE. 
THE PLACE OF INDIVIDUAL GYMNASTICS IN 
PHYSICAL EDUCATION. 
Physical education is the all-around training whereby 
the potential possibilities of an individual may be developed 
to a high degree—not alone the physical, but mental and 
spiritual as well. Its object is the attainment of a well- 
adjusted and coordinated organism—a controlled mind and 
body, which may best meet all situations in life. Health, 
strength, skill and beauty are the physical by-products. 
Bodily activities of various types are some of the tools 
by which this goal may be achieved. These activities may 
be classified into two groups, though allied in their aim, 
for the development of the individual to the utmost of his 
capacity. 
In the first group may be included gymnastic exercises, 
dancing, plays, games and sports. It is not the purpose 
to enter into a discussion of this group at this time, but 
to direct attention to the other branch, that of medical 
gymnastics. Medical gymnastics comprises exercises based 18 
INDIVIDUAL GYMNASTICS 
on anatomical and physiological principles, performed by 
the individual alone or with assistance, for the prevention 
or arrest, the cure or correction of some definite functional 
or organic disability or deformity. 
These exercises should never be undertaken by an inexperi- 
enced person without proper guidance or instruction. To 
the same extent as the physician who prescribes medicine, the 
true teacher of medical gymnastics assumes responsibility 
for prescribing exercises, and should, therefore, have medical 
training as a basis for its intelligent and safe application. In 
the absence of such training, however, work may be done 
under a physician who understands the conditions and directs 
the treatment. 
It is interesting to trace the history of medical gymnastics 
and to note that it seems to have had its beginning almost 
with the history of man. The earlier civilization exhibited 
an instinctive appreciation of the value of exercise. It was 
not, of course, what is now known as medical gymnastics— 
a carefully graded system—but some sort of exercise for 
remedial purposes has been in use from earliest times. 
Primitive man seems to have recognized that certain bodily 
ailments were benefited by physical activity. 
Records and pictures have been found representing the 
use of medical gymnastics by the Chinese, at least three 
thousand years b.c. One old record states that “gymnastic 
exercises stimulate bodily fluids to an even motion, which 
constitutes a condition of health. This motion is facilitated 
by the lying position and impeded by the upright position.” 
Exercises and manipulations have been used in the same 
connection by Egyptians, Hindus and other Eastern nations 
for many centuries, and were a part of the stock in trade 
of the priesthood, who were the medical men of earlier eras. 
The Greeks and Romans employed exercise for its beneficial THE PLACE OF INDIVIDUAL GYMNASTICS 
19 
effect quite universally, and Asclepiades and Celsus, at about 
the beginning of the Christian Era, prescribed exercise for the 
cure of many diseases, and for counteracting the effect of the 
effeminate luxury of the Romans. The importance of exer- 
cise in its effect upon mental states, which today is considered 
one of its most desirable results, was recognized by Pliny, 
whose philosophy has sent this message through the ages, 
“The mind is stimulated by movements of the body.” 
During the Middle Ages we are able to trace its use also, 
and it began to grow in importance, especially in the Sixteenth 
and Seventeenth Centuries. And so down the centuries to 
the present time, medical gymnastics has occupied a definite 
place as a therapeutic agent. The Swedish system was formu- 
lated early in the Nineteenth Century by Dr. P. H. Ling. 
This is a carefully chosen collection of exercises, based on 
anatomical and physiological principles, and is very generally 
used. 
For greater convenience and to facilitate its study, medical 
gymnastics may be subdivided into two parts: 
1. When it is applied to what may be called medical con- 
ditions the term “remedial” is used. 
2. When it is applied to orthopaedic conditions, or those 
of impending or existing deformity, it has been designated 
as “corrective gymnastics.” 
The word “orthopaedic,” from two Greek words—orthos, 
right; paidos, child—originally embodied the idea of the 
correction of deformities of children. It has now come, 
however, to have a broader application and to include the 
consideration of alterations in the symmetry and proper 
adjustment of the body structure, both of children and adults. 
The most common of these abnormalities which come under 
the observation of the teacher of physical education may 
be grouped as follows: 20 
INDIVIDUAL GYMNASTICS 
1. Anteroposterior faulty postures. Deviations from the 
properly adjusted body in the plane from front to back, 
known as the anteroposterior. 
2. Scoliosis, or lateral curvature of the spine. 
3. Abnormalities of the feet. 
Conditions such as bow-legs, knock-knee, deformities 
resulting from infantile paralysis, and others may be 
observed; but as these are almost entirely within the pro- 
vince of the orthopaedic surgeon, they should be referred 
to him for diagnosis and subsequent treatment. However, 
it is of the utmost importance that teachers of physical 
education should be able not only to recognize these con- 
ditions but also to grasp understandingly their character 
and degree. Care must always be taken that the teacher 
shall keep within the limits of the profession and not tres- 
pass upon the medical or surgical field for which he or she 
has not been trained. 
Besides the improvement by corrective exercises of what 
have been characterized as orthopaedic conditions, the 
teacher should for various reasons, be prepared to meet other 
needs of individuals for special rather than class work. 
This will be the experience especially of those who are 
teaching older girls or college women. Pupils exhibiting 
conditions such as poor circulation, anemia, ptosis, sluggish 
digestion, constipation, general low vitality, nervous insta- 
bility, disturbances of the menstrual function, and insuf- 
ficient breathing should be excused from regular class 
gymnastics, but they should not be denied thereby the bene- 
fits of exercise. A program of individual exercises should 
be substituted. 
As little emphasis as possible should be laid upon the 
fact that the pupil exhibits an abnormal condition: that 
he has been segregated from his companions in order that THE PLACE OF INDIVIDUAL GYMNASTICS 
21 
he may be “corrected.” The term “corrective’ has too 
often been a stigma, and has a tendency to cause intro- 
spection, morbidity and self-consciousness—most unde- 
sirable concomitants. While it is essential, to some extent, 
to direct attention to definite purposes, it must be done 
carefully, and the interest aroused in such ways as to create 
an atmosphere in which the individual is conscious merely 
of being a pupil working with an instructor toward a pur- 
poseful goal, rather than of being a “patient” or a “case” 
who is receiving treatment. It will be seen, then, that the 
differentiation is between class and individual gymnastics, 
and that “individual gymnastics” is a better term than 
“corrective gymnastics” for this type of work. 
In many schools, colleges and Young Women’s Christian 
Associations the need is being recognized, and departments 
for individual gymnastics are being established, under the 
direction of special teachers whose entire time is devoted 
to such work. The results obtained have been most gratify- 
ing. The aim in all cases is to make the work progressive, 
in order that the pupil may, through improvement of con- 
dition, be transferred from individual to class exercises as 
soon as possible. The pupil is also encouraged to partici- 
pate in all healthful activities, dancing, games and sports, 
with strong emphasis on recreational values. 
Thus, individual gymnastics has a definite place, and one 
of much value in the great program of physical education, 
the goal of which is worthy living and social realization 
through the development of the psycho-physical potentiality 
of the individual. CHAPTER II. 
EQUIPMENT. APPLICATION OE INDIVIDUAL 
GYMNASTICS. GENERAL DIRECTIONS. PLAN 
OF EXERCISE PROGRAM. TEACHER’S 
RESPONSIBILITY. PSYCHOLOGY OF 
INDIVIDUAL GYMNASTICS. 
EQUIPMENT. 
Apparatus.—The apparatus required is fairly simple. A 
large number of mechanical appliances is unnecessary. 
These are used, to some extent, in hospitals and in the gym- 
nasiums of the specialists where extreme conditions are to 
be met, and by their means more forceful correction can be 
applied and the strength of the instructor conserved. 
The minimum equipment, however, should include one 
horizontal bar, adjustable to different heights; several 
heavy mats; stall bars and benches; a narrow plinth, and a 
few wands and dumb-bells of various weights. Valuable 
adjuncts for training in muscle control are mirrors, adjusted 
at angles permitting observation of the figure from the front, 
back and side. These mirrors are especially useful in the 
correction of posture. The ideal arrangement is to have a 
central mirror fixed to the wall, with a hinged mirror of the 
same size attached to each side, which may be adjusted at 
all angle*; but a less expensive way is to fix two mirrors at 
right angles in a corner and use a full-length dressing mirror 
in addition, which can be moved about easily to accomplish 
the desired result. EQUIPMENT 
23 
A Swedish boom is often useful, also a pair of rings. 
The gymnasium plinth illustrated is an excellent piece of 
apparatus; the special features are its height, narrow body, 
and the movable foot supports, which make it adaptable 
to many sorts of exercises. It may be purchased from the 
Narragansett Machine Company, Providence, R. I., if 
desired. 
Fig. 2.—Gymnasium plinth. 
The Gymnasium Suit.—The gymnasium suit should be 
arranged so that the baek of the pupil may be easily exposed 
at any time during the lesson. It is almost useless to try 
to obtain results worth while if the teacher is unable in 
this manner to observe frequently the effect of the exer- 
cises. After many experiments, we solved the problems 
of utility and economy by requiring each pupil to wear 
bloomers, and a middy blouse cut open the entire length 
of the back and closed with snap fasteners or buttons. In 
such a garment, the figure is completely covered or may 
be laid bare at a moment’s notice. 24 
APPLICATION OF INDIVIDUAL GYMNASTICS 
Shoes. —Gymnasium shoes should be worn, or better still, 
no shoes at all, and the straight position of the feet empha- 
sized, so that the muscles may be used with perfect freedom, 
and the feet thereby be strengthened. An extra pair of 
stockings or pair of men’s socks, which can be slipped on 
over the other stockings, makes a desirable substitute for 
the gymnasium shoe. 
THE APPLICATION OF INDIVIDUAL GYMNASTICS. 
In the application of exercises, too much stress cannot be 
laid on the importance of making the lesson individual. 
Preferably, only one pupil should receive attention at a time. 
With children there should never be more than two, and in 
such cases, the exercises ought to be so planned that one 
child may receive the maximum attention from the teacher 
when performing the more difficult and carefully localized 
exercises, while the other is doing simpler work, that requires 
less supervision. Some children work better if there are 
two together, as there is the increased incentive of com- 
petition. With others this is not at all desirable, as the 
attention may be distracted and concentration lost. Con- 
sequently, no positive rules can be laid down and decision 
as to the best method with each pupil must be left to the 
discernment of the teacher. 
Under some circumstances when, with limited time, it is 
necessary to provide for many lessons as in schools and 
colleges, it has been found possible to organize small groups 
whose lessons can be satisfactorily supervised by one 
instructor. The size of the group should be regulated by 
the judgment of the teacher, with reference to the types of 
exercises necessary and the seriousness of the conditions 
needing attention. The field of individual gymnastics is APPLICATION OF INDIVIDUAL GYMNASTICS 
25 
broadening rapidly, and at the present time so many inquiries 
are being made by instructors in physical education, who 
are dealing with large classes as to the possibility of individual 
work with groups, that ways and means must be found of 
meeting the need in some way. The discussion of this 
subject will be taken up more at length in a succeeding 
chapter. 
After a physical examination, a program of exercises is 
planned by the teacher, which will meet the requirements of 
the pupil. This program is carried out at each subsequent 
lesson under personal supervision. Exercises should be 
definite, executed carefully and slowly, and repeated day 
after day with little variation. It is not necessary to change 
the program frequently, as progress does not mean the 
acquirement of many new movements, but rather proficiency 
in a few. More benefit may be gained by obtaining perfec- 
tion of form and ease of execution in a fewT exercises, than by 
doing a larger number carelessly, or with strain. However, 
from the point of view of stimulating interest, it is wise to 
change exercises from time to time—perhaps only by an 
altered position of the hands, or an increase in the number 
of times an exercise is performed. 
Length and Frequency of Lessons.—A lesson period varies 
from thirty to thirty-five or forty minutes, depending upon 
the general condition, age, strength and endurance of the 
pupil. With a young child or one showing a condition of 
weakness, or in the case of an old person with little resistance, 
for example, the lesson at first may be limited to a fifteen- 
minute period. Work should be intensive, with definite 
intervals of relaxation, and modified at the discretion of the 
teacher. Daily lessons are advisable in every case when 
possible, especially where there are extreme conditions or 
persistent deformities. Only by this means can the best 26 
APPLICATION OF INDIVIDUAL GYMNASTICS 
results be reached. If a daily lesson is impossible, three a 
week should be urged. Two lessons a week should be the 
minimum, and hardly sufficient when dealing with unusual 
conditions. It is well to teach one or two simple exercises 
that may be done at home. Instructions in regard to the 
general hygiene, and stressing the need of standing and 
sitting correctly are of prime importance and should never 
be omitted. Each lesson should be terminated by a five- 
minute period of relaxation, lying flat on the mat. If the 
lesson period is of forty or fifty minutes’ duration, it is 
desirable to divide the period by five minutes’ relaxation 
also. Better results are reached by a fifteen or twenty 
minute period of intensive work, followed by five minutes’ 
relaxation—then another intensive period, with a final relax- 
ation in the lying position. 
Objectives.—In the application of exercises to individual 
needs, it will be noticed that the lines along which it will be 
most desirable to work in the reestablishment of symmetry 
and of normal conditions, are fairly definite, and may be 
stated as follows: 
1. Improvement of the general condition. 
2. Strengthening muscles. 
3. Increase and equalization of flexibility. 
4. Readjustment of muscle control. 
Types of Exercises. —Exercises are grouped, according to 
type, into passive, assistive, active and resistive. 
A passive exercise is one wherein the muscles are without 
active effort on the part of the pupil, exercised solely by the 
aid of the teacher. 
In cases of extreme muscular weakness, such as may follow 
a debilitating illness, or after infantile paralysis, these passive 
exercises are of great value. They are also used with good 
results in stretching contracted tissues, and in limbering up 
stiff joints where movements have become limited. APPLICATION OF INDIVIDUAL GYMNASTICS 
27 
The assistive exercise is executed actively, according to the 
ability or strength of the individual, aided by the teacher in 
order to make the movement of greater range or strength. 
The active exercise is performed by voluntary muscular 
action without assistance. 
A resistive exercise is used in order to make a movement 
more vigorous. There are two types, both executed against 
resistance. 
In the concentric resistive exercise, the muscles contract 
and shorten, overcoming the resistance. 
In the eccentric resistive, the muscles, though in strong 
contraction are at the same time being lengthened by the 
resistance—that is, the resistance is overcoming the muscular 
contractions. 
By far the larger number of exercises are of the active 
type. The greater value of these is being recognized more 
and more, while passive and resistive exercises are usually 
reserved for special conditions. This is not alone from the 
point of view of the comparative value of the exercises, but 
for the conservation of the teacher’s time and strength, a 
highly important consideration. The expenditure of energy 
by the teacher, with the pupil as a more or less passive agent, 
has oftentimes been tremendous, and out of all proportion 
to the results accomplished. 
One of the chief values of active exercises is that they 
develop powers of subjective motor control. The individual 
becomes conscious of the body mechanism as a working 
entity, with all its parts related segments. Arm and leg 
movements, for example, are seen not as simply local move- 
ments, but as purposeful activities which will help in the 
establishment of a finer adjustment of the whole body. The 
fact that these exercises can be performed without assistance 
or apparatus, even in a limited space, makes them practical. 28 
PLAN OF EXERCISE PROGRAM 
PLAN OF EXERCISE PROGRAM. 
It is the common experience that in planning programs the 
number of exercises required is comparatively small, for 
the same ones can be used with such slight variations as 
make them adaptable to various conditions. There are 
some “old reliables” which have proved indispensable and 
have been used almost from the beginning of corrective work. 
For them no substitutes have been found. Others, hopefully 
welcomed as “something new,” have been tried and dis- 
carded as of little or no intrinsic value. 
We have also to guard against stock sets of exercises, for 
it is a fact that no two pupils are exactly alike. Teachers 
frequently ask for “a set of exercises” or a list of movements 
for “round shoulders,” “lateral curvature” or some other 
condition, but a routine list should be given with care, with 
the understanding that it should be subject to modification, 
as there is a possibility that harm rather than improvement 
might result otherwise. 
For the convenience of the teacher, exercises should be 
grouped as nearly as is possible with reference to their special 
application, then from these groups such exercises can be 
chosen as will meet the needs of the case in hand. 
In planning a program the intelligent understanding of 
the individual condition is most important. The uninitiated 
teacher seeing, for example, a child with stiff, round shoulders 
might think she was doing her duty conscientiously by 
giving six or eight exercises directed entirely to the local 
.condition of the shoulders, not appreciating the fact that 
it is the readjustment of the whole body that is necessary. 
The program should include exercises for improving the 
general condition, for the weak abdominal muscles, to 
increase the lung capacity, to improve coordination, but, PLAN OF EXERCISE PROGRAM 
29 
above all, the proper mental attitude toward correction 
must be established. 
Fig. 3.— Showing the possibilities of supervised individual work with a group in a gymnasium with simple 
equipment. (Individual Gymnastics, Central School of Hygiene and Physical Education, New York City.) 30 
PSYCHOLOGY OF INDIVIDUAL GYMNASTICS 
The program is also constructed much after the manner 
of a “day’s order.” It should be so arranged as to progress 
from simple exercises at the beginning up to the more difficult 
ones and then slow down toward the end. If the pupil is 
delicate, or if there is any heart weakness present, the pulse 
should be taken at the beginning and end of the lesson to 
determine whether it has been too severe. A record of the 
weight is also helpful, as any marked decrease might be an 
indication that the general condition was falling below par 
and should be investigated. 
THE TEACHER’S RESPONSIBILITY. 
The question as to the amount of responsibility which a 
teacher may assume, is an important one. Care should be 
taken not to go beyond the prerogatives of the profession. 
With a child, in case an abnormal condition has been 
observed, the attention of the school physician ought to be 
drawn to it. The parent should be notified, with the sugges- 
tion that the family physician be consulted. Thus the initial 
responsibility is placed with the parent. It is understood 
that the teacher is ready to cooperate by giving advice if 
called upon, and in planning and carrying out exercises. 
With adults, it is also wise to urge medical advice. If there 
is any doubt in the mind of the teacher, or a condition 
exhibits persistent pain, a physician’s diagnosis should be 
insisted upon, and no exercises given except by authority. 
THE PSYCHOLOGY OF INDIVIDUAL GYMNASTICS. 
The teaching of individual gymnastics is not alone the 
ability to apply certain routine exercises to fit such and such 
a condition. In fact, this is the least part of the work. In PSYCHOLOGY OF INDIVIDUAL GYMNASTICS 
31 
addition thereto the teacher needs to be a practical psychol- 
ogist. A child may be “put through’’ a list of exercises for 
half or three-quarters of an hour, and the benefit be nil, as 
compared with the result to be obtained from a fifteen- 
minute period where such a relation between the teacher 
and pupil has been established through arousal of interest, 
that the latter recognizes the fact that it is a cooperative 
plan, with both teacher and pupil working toward a pur- 
poseful goal. 
Dr. Dewey makes a statement to the effect that “Drill 
is valueless when it becomes a meaningless, unthinking 
process of repetition.”1 This thought is peculiarly appli- 
cable to individual exercises. If the work is executed in 
a routine way, motivated only by a sense of unavoidable 
duty, with eyes on the clock and the thoughts elsewhere, 
the time is wasted. There may be an external form mani- 
fested temporarily, but the internal stimulation is what 
really brings results. Exercises that lead to intensive 
habit-forming, require active thought in the doing. There 
must be an appreciation of the need for the work, a reason 
for the repetition of the exercises over a long period of time, 
and a desire to accomplish results. 
The teacher’s task is no light one. There must be infinite 
tact and patience with unbounded enthusiasm on the part 
of the instructor. The wise teacher will set up objectives, 
catching the interest through “purposeful activity.” The 
individual will see herself not as she is but as she desires 
to become. The stimulation of interest is all-important. 
There will be necessarily a different appeal, according to 
age and temperament. One of the most difficult problems 
is with the child who comes for exercises because he is being 
1 Dewey: “How We Think.” 32 
PSYCHOLOGY OF INDIVIDUAL GYMNASTICS 
sent. Yet no child is without some pride and interest. 
The tactful teacher must find the vulnerable point and so 
establish a foundation on which to build. In many instances 
it is helpful to explain the reason for doing the exercise- 
even elementary instruction in anatomy may be made 
interesting—thereby dispelling the feeling that the teacher 
is imposing an arbitrary and oftentimes distasteful pro- 
gram. The promise of promotion to class work as soon as 
sufficient improvement is shown, has a salutary effect. 
Many people are highly sensitive, and embarrassment and 
self-consciousness may often be mistaken for indifference. 
There is a certain type with whom there must be constant 
appeal to the pride, while another type merely needs encour- 
agement, and at the risk of reiteration we urge a careful 
consideration of individual differences. A teacher who is 
not interested in the study of human nature, or who has 
not tact and adaptability, will fail in the field of individual 
gymnastics, even though her technical knowledge be com- 
plete. CHAPTER III. 
ANATOMY OF THE HUMAN BODY. PLANES OF 
THE BODY. PHYSIOLOGICAL CURVES. 
INCLINATION OF THE PELVIS. 
MOVEMENTS OF THE 
SPINE. 
ANATOMY OF THE HUMAN BODY. 
The human body is a segmented mechanism. Its frame- 
work of bones, the skeleton, held together by ligaments and 
moved by muscles through stimulation by the nervous 
system, is capable of constant and intricate adjustments 
for the purposes of weight-bearing and the maintenance of 
equilibrium. 
In order to have a clear understanding of the maladjust- 
ments which are present in conditions of faulty posture, 
scoliosis, and so forth, it is essential to have in mind the 
normal anatomy, especially as to the interrelation of these 
movable segments. 
The Vertebral Column, Spinal Column, or Spine, is composed 
of a series of vertebrae superimposed on one another, with a 
disk of fibrocartilage between each two with the exception of 
the first two cervical vertebrae, the atlas and axis. These 
intervertebral disks which are firmly attached to the bodies 
of the vertebrae give elasticity and mobility to the spine 
and serve to lessen the jar incident to bodily activity. 
The Vertebra.—There are thirty-three of these bony 
masses. The upper twenty-four are known as the movable 
3 34 
ANATOMY OF THE HUMAN BODY 
or presaeral vertebra. Of these, there are seven cervical, 
twelve dorsal or thoracic, and five lumbar. The lower nine 
are fused together to form the sacrum and coccyx, and are 
called the fixed or immovable vertebra. 
Each vertebra, roughly speaking, consists of an irregular 
ring of bone surrounding an opening known as the vertebral 
foramen. When the vertebra are superimposed to form the 
column, these foramina constitute the vertebral canal which 
encloses and protects the spinal cord. 
DEMIFACET FOR 
HEAD OF RIB. 
SPINAL 
FORAMEN. 
PEDICLE. 
SUPERIOR ARTICU- 
LAR PROCESS. 
LAMINA 
•ssaoourf* 
SHONIdS 
Fig. 4.—A thoracic vertebra seen from above. (Gerrish.) 
The features common to all vertebne, with the exception 
of the atlas and axis, are the body; two transverse processes; 
four articular processes; one spinous process; two pedicles 
and two laminae (Fig. 4). 
On the thoracic vertebrae are facets showing the points 
of attachment of the ribs. The presence of these facets and 
the downward obliquity of the spinous processes are the dis- 
tinguishing characteristics of the thoracic vertebrae. 
The lumbar vertebra1 are much heavier and the spinous ANATOMY OF THE HUMAN BODY 
35 
processes more nearly horizontal, while the cervical verte- 
bra? are lighter, have foramina in the transverse processes 
and the spinous processes are bifid. 
The Ribs.—There are twelve pairs of ribs which articulate 
posteriorly on the bodies and transverse processes of all the 
thoracic vertebra?. The upper seven pairs are attached 
anteriorly by means of cartilage to the sternum; the next 
three to the cartilages of the ribs above, while the last two 
are free, and are called the “floating ribs.” 
Thorax.—The body cavity formed by the articulation of 
the spine, ribs and sternum is called the thorax. It is 
strengthened and protected above by the shoulder girdle, 
which is formed by the scapulae and clavicles. 
Scapulae.—The scapulae, or “shoulder-blades,” are trian- 
gular in shape and lie one on either side of the spine, their 
vertebral borders equidistant about one inch, and are super- 
imposed over the posterior aspect of the ribs from the second 
to the seventh or eighth. 
Clavicles.—The two clavicles, or “ collar bones,” are slender, 
flexible and curved, and articulate at one end with the 
sternum, and at the other with the acromion process of the 
scapula. 
The Occiput, or Head, is balanced upon the first cervical 
vertebra or atlas, and obtains great freedom of motion 
through the movement of the atlas upon the axis. 
The Humerus, Ulna, Radius and Bones of the Hand complete 
the jointed mechanism of the upper extremity, their points 
of articulation forming the shoulder, elbow, wrist and finger- 
joints. 
The Pelvis.—The pelvis forms the base of support for the 
spine; is analogous to the shoulder girdle and is sometimes 
called the pelvic girdle. It is formed by two bones, the ossa 
innominata, meeting anteriorly at the symphysis pubis, and 36 
ANATOMY OF THE HUMAN BODY 
articulating posteriorly with the sacrum at the sacro-iliac 
joints. The pelvis is supported in its turn upon the bones 
of the lower extremity; the femur, tibia, fibula and bones of 
the feet. 
Ligaments.—The bones of the skeleton are firmly bound 
together by the ligaments, strong bands of inelastic fibrous 
tissue, forming a strong capsule around each joint. The 
ligaments of the vertebral column are numerous. They are 
so arranged as to give great strength and to limit the move- 
ments of the spine. The anterior and posterior common 
ligaments connect the bodies of the vertebrae all the way 
from the atlas to the sacrum. The ligamenta subflava con- 
nect the laminae; the capsular surround the articular pro- 
cesses; the spinous processes are connected by the supra- 
spinous and the interspinous ligaments, which a recontinued 
from the seventh cervical vertebra to the base of the skull, 
by the strong ligament of the neck, the “ligamentum 
nuchae”; while the transverse processes are connected by the 
intertransverse ligaments. 
The Y-ligament or Iliofemoral Band.—This is one of the 
most essential ligaments in the body and is of great import- 
ance in its support in the upright position. It is part of 
the capsule of the hip-joint, extending diagonally across the 
hip-joint anteriorly from the ilium to the head of the femur 
in the form of an inverted Y. 
Muscles.—It is necessary to have in mind, not only the 
location and action of the individual muscles, but also to 
have an understanding of the working of muscles by groups, 
and their action in bodily movements as motor, fixator, 
antagonistic or steadying agents.1 
On the front and back of the body, groups of muscles 
1 Refer to Bowen’s Applied Anatomy and Kinesiology. ANATOMY OF THE HUMAN BODY 
37 
called antagonistic are situated, the proper tone of which 
has direct bearing upon the maintenance of the erect posture, 
Fig. 5.—Diagram showing the action of antagonistic muscles which keep 
the body erect. (After Huxley.) Arrows indicate the direction of the pull, 
the feet serving as a fixed basis of support. The muscles A, B, H and C 
keep the body from falling forward; D, E, F and G keep it from falling 
backward. (Hough and Sedgwick.) 
by keeping the segments of the body in correct relation to 
one another. 38 
ANATOMY OF THE HUMAN BODY 
1. Groups connecting the head to the trunk. 
2. Groups connecting the trunk and pelvis. 
3. Groups connecting the pelvis and lower extremity. 
(Fig. 5.) 
PLANES OF THE BODY. 
Anteroposterior or sagittal plane passes through the body 
from head to feet in the axis from front to back. When 
observation of the body is made in this plane it is seen in 
profile. Frontal or coronal plane passes through the body 
from head to feet at right angles to the antero-posterior 
plane. Transverse plane cuts the body horizontally. 
PHYSIOLOGICAL CURVES OF THE SPINE. 
The normal or physiological curves of the spine (Fig. 6) are 
formed early in life as soon as the upright position is assumed. 
They give ease and elasticity to the body in its activities. 
These curves are in the anteroposterior plane, concave for- 
ward in the cervical region, convex backward in the thoracic 
region and concave forward in the lumbar region. In the 
position of rest, these curves are kept in proper place by the 
balance of antagonistic muscles. It is their exaggeration 
that is the outstanding feature in faulty posture. In the 
young infant these curves are not present — the spine 
making one long curve backward in its entire length. 
INCLINATION OF THE PELVIS. 
In all departures from the normal symmetry of the body, 
especially in faulty anteroposterior postures, the position 
of the pelvis in relation to the horizontal plane should be 
considered, since it is especially liable to change. Either INCLINATION OF THE PELVIS 
39 
the inclination will be increased, that is, the pubic arch will 
be tipped downward too far, or the inclination will be 
CERVICAL 
VERTEBRAE 
THORACIC 
VERTEBR/E 
LUMBAR 
fERTEBRiE 
SACRUM 
COCCYX 
Fig. 6.—Showing physiological curves and regions of the spine. (Gerrish.) 
decreased, and the pubic arch in this case will be tilted 
upward. Increased inclination accompanies exaggeration of 40 
ANATOMY OF THE HUMAN BODY 
the lumbar curve (lordosis), and decreased inclination is 
found when the lumbar curve is too flat or when the person 
stands with the body weight over the heels. 
Fig. 7.—Inclination of the pelvis. Median section through the pelvis: 
P, pubes; C, pubic crest; S, sacrum; S.A., sacral angle; P.S., posterior 
spine. (Spalteholz.) 
The normal inclination of the pelvis is determined by a 
line drawn from the sacrolumbar junction through the sym- 
physis pubis and projected downward to meet a horizontal 
line with which it makes a certain angle. Many obser- MOVEMENTS OF THE SPINE 
41 
vations have been made and the generally accepted con- 
clusion is that the inclination in the normal woman is slightly 
greater than in man, but that both come within a range of 
from 50 to CO degrees (Fig. 7). 
When we consider that the pelvis is the base of support 
for the spine and therefore of the trunk as well, it is evident 
that the angle of inclination has a most important bearing 
upon the posture of the trunk, as any alteration in the posi- 
tion of the pelvis will cause an adjustment of the superim- 
posed structure. Its position, therefore, becomes one of the 
initial considerations in the establishment of a correct posture 
—a fact often overlooked. 
MOVEMENTS OF THE SPINE. 
Because of the anatomical structure of the spine and 
thorax, there is less freedom of motion than appears to the 
casual observer. The apparent flexibility of the spine is 
due to the freedom possible in the upper cervical region by 
movements of the head and by action of the whole spine 
on the pelvis. Movement in the hip-joint is often mis- 
taken by the casual observer for movement of the spine. 
The importance of bearing this in mind will be seen in the 
application of exercises, where proper localization is essential. 
Deductions have been drawn as to the relative degree of 
movements possible in the different regions of the spine, as 
follows i1 
Flexion. —1. Considerable in cervical region between head 
and spine; slight in the rest of the cervical region. 
2. Thoracic region. Slight. 
3. Lumbar region. Very free. 
1 Lovett: Lateral Curvature of the Spine and Round Shoulders. 42 
ANATOMY OF THE HUMAN BODY 
Hyperextension. —1. Cervical. Slight. 
2. Thoracic. Slight. 
3. Lumbar. Very free. 
Lateral Bending and Rotation. —1. Cervical. Free lateral 
bending with slight rotation. 
2. Thoracic. Less free lateral bending with considerable 
rotation. 
3. Lumbar. Very free lateral bending with little rotation. 
Slight. CHAPTER IV. 
THE UPRIGHT POSTURE. VALUES OF POSTURE. 
THE UPRIGHT POSTURE. 
Before entering upon a study or description of the faulty 
attitudes or postures which are astonishingly prevalent, it is 
well to make some rather careful deductions from present 
knowledge of the much-discussed erect posture. What is 
the ideal posture of the human body, and what is the signifi- 
cance of the emphasis which is placed upon it? It has been 
said that man was intended originally to walk on “all-fours,” 
but that through the developmental phases of evolution he 
has acquired the unique habit of standing erect. For this 
distinction, however, he often pays the price of various con- 
sequent ills, such as flat-feet, varicose veins, hernias, scolioses 
and faulty postures. It is obvious that to preserve the 
equilibrium while walking upright requires an accurate 
adjustment depending upon a fine neuromuscular control. 
The problem is that of keeping the body at all times in such 
relation to the center of gravity that this upright position 
may be maintained with a minimum amount of effort. 
These adjustments would be unnecessary if the body were 
supported in the horizontal position, upon four feet instead 
of upon two. One writer has most aptly said that the human 
mechanism is “a quadruped skeleton, set up on end.” 
Center of Gravity.—The center of gravity of the body varies 
slightly with individuals. Through observations and experi- 
ments by Drs. Lovett and Reynolds, the following conclu- 
sions have been reached: 44 
THE UPRIGHT POSTURE 
“In the erect position the center of gravity of the body 
lies in front of the ankle-joints, which are held from dorsal 
flexion in this position by the gastrocnemius muscles. The 
center of gravity lies also in front of the knees, which are 
similarly held in position by the hamstring and quadriceps 
extensor muscles. The center of gravity lies also anterior 
to the sacro-iliac joints and most of the vertebral joints. 
“In the erect position the trunk is held extended on the 
legs by the combined and continued action of the posterior 
musculature, the chief factors here being the hamstrings, 
the glutei and the erector spinse muscles.”1 
The arrangement of muscles on the front and back of the 
body and their action in keeping the body erect, has been 
likened to the arrangement of guy ropes on a flagstaff, which 
by their equal pull on all sides enable the staff to maintain 
its perpendicular position. 
As the body weight is supported on the lower extremi- 
ties, then if the axes of the body segments, the head, trunk 
and legs are in such relation to one another that they 
approximate a straight line, it can be easily seen that such 
weight would be supported in the most economic way and 
balance would be preserved with the least resistance to the 
center of gravity. If, on the other hand, these segments 
form a series of angles with one another, thus falling out of 
alignment with the center of gravity, balance is disturbed, 
the muscles no longer pull equally, the resistance to gravity 
is increased and the body is in a less advantageous position 
for its activities (Fig. 8). 
There are certain undeniable advantages in the upright 
posture of great value to man in his activities, aside from the 
esthetic aspect. The opportunity for free use of the hands 
1 Lovett: Lateral Curvature of the Spine and Round Shoulders. THE UPRIGHT POSTURE 
45 
and arms would not be possible in the horizontal position, 
and the number and range of movements would be fewer and 
more restricted. It is noticeable that among the mentally 
A B 
Fig. 8.—A, axes of body segments, a series of diagonal lines; B, axes of body 
segments, a series of straight lines. 
defective, relaxation from the upright position is a marked 
characteristic, and as mental control becomes less, there is a 
tendency to return to the horizontal position. 46 
THE UPRIGHT POSTURE 
ANALYSIS OF CORRECT POSTURE. 
For the term “good posture” no absolutely definite 
standard can be given. It is the proper relationship between 
the parts of the body which corresponds to an ideal in the 
mind of each individual by which he almost instinctively 
recognizes “good posture” as distinct from “poor posture” 
although oftentimes he does not live up to this ideal. Good 
posture indicates mental and physical poise. The body 
should be well balanced, in a position of ease, with the weight 
borne equally on both feet, the knees and hips extended, 
but not hyperextended; the body should be held as tall as 
possible, without strain; the head erect and easily poised, 
with no tension in the neck; chest elevated; abdomen 
retracted; arms hanging easily from the shoulders. 
In teaching this posture, it is a mistake to call attention 
to too many of the body segments. Simple directions are 
best. An awkward and stiff posture is liable to result from 
such instructions as these: “Head up: Shoulders back: 
Chest high: Abdomen in: Hips back:” etc. A much better 
result is attained by giving a simple explanation of the 
meaning of good posture in the beginning, followed by the 
direction, “Stand as tall as possible,” or “Pull up with the 
head—keep the chin horizontal.” This usually brings a 
good response. Ease and freedom from tension should be 
emphasized. 
The inclination of the pelvis is of great importance, as it 
controls the position of the spine. Considerable attention 
should be given to training the pupil to learn the muscular 
coordinations which shall enable him to control the position 
of the pelvis. The most common fault is that of throwing 
the hips too far back, and thus exaggerating the lumbar 
curve. The muscles of the lower back and waist usuallv VALUES OF GOOD POSTURE 
47 
need to be strengthened in order that they may hold the 
trunk in such stable position that the superincumbent 
structures of necessity become properly adjusted, the chest 
elevated, the head well poised, and the arms easily pendent 
at the sides of the body. 
In this position the body is in its most advantageous 
adjustment for work and the individual is ready for instant 
response to any stimulus with the least output of effort. 
Conservation of time and energy are the keynote of this, 
as of every endeavor. As the great demand of the world 
is for efficient service, each individual should meet the need, 
as a matter of individual responsibility, by making himself, 
as far as possible, a well-developed and adjusted whole, in 
order that he may best perform the work that he under- 
takes. 
VALUES OF GOOD POSTURE. 
The values of good posture may be grouped as hygienic, 
economic, social and esthetic. If we appreciate these values 
fully we must see that good posture becomes an asset of 
importance. 
Hygienic.—It is of comparatively recent date that the 
bearing of posture upon health has been realized. Formerly, 
the chief arguments for good posture were from the esthetic 
viewpoint. But to stand erect, to walk easily, to have a 
well-adjusted body are far- more important from the stand- 
point of health. This has been made the subject of extensive 
observation and study by some of the eminent physicians 
and surgeons of the present day, I)r. Goldthwait lays great 
stress upon its significance in the diagnosis of ailments seem- 
ingly of obscure origin, and traces a long and pernicious 
train of ills to faults of bodily posture.1 
1 Goldthwait: Relation of Posture to Human Efficiency. 48 
THE UPRIGHT POSTURE 
In the well-poised body all the organs are held in the best 
position for the proper performance of their functions. The 
chest is expanded, giving room for the lungs and heart, and 
thus the great processes of respiration and circulation can 
be carried on normally; there is no cramping of the stomach 
and liver, while the retraction of the abdominal walls sup- 
ports the enclosed viscera in their elevated and natural 
relations. Consider the reverse of this picture—the relaxed 
posture, drooping shoulders, depressed chest, protruding 
abdomen—with the resulting maladjustment of the organs. 
The lungs will be cramped, there will be less room for the 
heart, the stomach and liver will receive undue pressure 
and there will be sagging of the abdominal and pelvic 
viscera. The functions of the organs are then interfered 
with, and the result may be seen in disturbances of the 
respiration, circulation, digestion and of the nerves, while 
many menstrual difficulties are correctly traced to “ptosis,” 
resulting in displacement of the pelvic organs. Such con- 
ditions indicate, at least, a lowering of the vital index and 
put the individual physically below par. The best work 
cannot be accomplished without a background of health, 
so a good posture, meaning better health, implies increased 
power. 
Economic.—The posture and bearing, which express dignity 
and poise, suggest latent power which impresses a would-be 
employer with confidence in one’s ability. In a report, not 
long ago, noting the qualifications of a good teacher, was the 
following statement relative to the importance of posture, 
“The applicant, otherwise well qualified, walked herself 
out of a 1500 dollar position in eight steps.” From this 
viewpoint the importance of an erect bearing cannot be over- 
estimated in the purely business consideration of the ability 
to secure and hold a position. VALUES OF GOOD POSTURE 
49 
Wherever she or he may be, classroom, business office, 
drawing room or place of emergency, the woman or man of 
erect posture will be first, in the nature of things, to receive 
attention and to command respect. 
Social.—A good posture reacts upon the individual in an 
increase of self-respect, and gives one confidence of his ability 
to present a good appearance before his neighbors, and a 
power to look the world in the eye. These values are 
undoubtedly greater than is realized. 
The relation between the physical, mental and spiritual 
natures is so close that one cannot be ministered to alone. 
Posture is expressive of mental states, so relaxation of posture 
implies mental relaxation as well. People are frequently 
unaware that they are expressing themselves in this way. 
Emerson says “ What you are, speaks so loudly that I can- 
not hear what you say.” It is a psychological fact that 
“The assumption of an attitude expressive of a certain 
emotion tends to produce that emotion.” Depression is 
expressed by a lowered head, a flattened chest, and robs 
the gait of buoyancy, but a fit of the “blues” cannot with- 
stand deep breathing and an erect carriage. Prof. James 
says, “Whistling to keep up your courage is no mere figure 
of speech; sit in a moping posture and your melancholy 
will linger.” It is almost instinctive to stand erect to 
overcome fear, and the first step in resisting defeat is to 
lift the chin. One of the greatest assets of the actor is the 
ability to convey impressions of emotions and characteristics 
to an audience by means of posture. A strong, erect posture 
expresses to the world at large, strength of will, alertness, 
poise, and the joy of living. All of which makes the indi- 
vidual a more useful social unit and a greater asset to the 
community. 50 
THE UPRIGHT POSTURE 
Esthetic.—From the point of view of appearance, good 
posture is important. An erect bearing is more pleasing to 
the eye than a “slouch,” and clothes show more graceful 
lines and appear at greater advantage when worn on a 
Fig. 9.—The young Franklin, by Dr. R. Tait McKenzie, University of 
Pennsylvania, Philadelphia, Pa. 
figure held with dignity. A youthful appearance can be 
preserved longer by holding a good posture than by using 
cosmetics, or by following the innumerable devices for pro- 
longing youth. VALUES OF GOOD POSTURE 
51 
Sculpture and painting offer interesting material for study 
of posture, both correct and incorrect, and the eye becomes 
trained to recognize lines of symmetry. Observation of 
those passing on the street impresses one with the fact that 
few people walk and carry themselves well. The -slouchy 
gait and awkward carriage are common. An alert, well- 
set-up individual is noticed at once, and an involuntary 
tribute is paid to the values of posture when we say, with 
approbation, “How well that person carries himself.” 
Posture should be dynamic, not static, and should pro- 
claim not alone the ability to assume an erect bearing in the 
gymnasium, under the eye of the instructor, but a well- 
coordinated mechanism, prepared at all times to meet any 
physical requirement in the best manner and with the great- 
est ease. It is not to be put off and on like a garment, but 
should be fundamental, functioning in all the activities of 
life. The aim is to acquire habits of good posture, rather 
than a habit. 
The lad who has established these powers of bodily con- 
trol will naturally assume better postures in his sports, 
and will consequently play a better game of baseball than 
his companion, who manages his body carelessly and less 
economically. The college girl will excel at tennis or as a 
member of the crew if she has learned that “posture” denotes 
the proper management of her bodily mechanism in all 
activities. 
Not only at the present time but through the history 
of past ages the subject of posture has been one of great 
moment. All people, however low in the scale of culture, 
recognize the power behind a confident, upright bearing as 
against a cringing apologetic attitude. The Greeks placed 
so great value on the ability of man to carry himself erect 
that they called it a special gift of the gods, the legend 52 
THE UPRIGHT POSTURE 
running that Prometheus created man to walk on two feet 
instead of four, and to gaze upon the stars, the abode of 
the gods. 
Posture is an index of personality. A poised and upright 
bearing* usually connotes strong mentality, health, self- 
command and leadership. There are exceptions to all 
broad rules, so it is possible to find a noble physique housing 
vicious tendencies; but this is rare, as the lower instincts 
are usually proclaimed otherwise. Almost, if not absolutely 
never, does a feeble-minded person stand upright; an 
unhealthy person is seldom erect, and the timid, self-con- 
scious individual is not commanding in bearing. 
Conversely it may be claimed that a man or woman 
who consciously and determinedly walks erect, gains in 
self-respect, improves in health and receives an impetus to 
clearer thinking and to ennobled living. It must then be 
conceded that posture is of deep psychological import. CHAPTER V. 
ANTEROPOSTERIOR FAULTY POSTURES. 
DIFFERENTIATION OF DISEASED CONDITIONS. 
It should be borne in mind from the outset that antero- 
posterior faulty postures are not conditions of disease of the 
spine, nor do they lead to it. They are the result of asym- 
metrical growth and faulty adjustment. 
There is a disease of the spine, however, known as Pott’s 
disease, or caries of the spine. This is a tuberculous condi- 
tion, which in its early stages might be mistaken for faulty 
posture. This disease is accompanied by pain, which should 
indicate to the teacher that exercise should not be given, 
but that the advice of a physician, preferably that of the 
orthopaedic surgeon, should be sought. 
It is well to remember that persistent pain is always a 
danger signal and its cause requires investigation. Great 
harm might be done if the teacher were not intelligent in 
this matter, for while exercise is the rational treatment for 
the correction of faults of posture, it is absolutely forbidden 
for diseased conditions. 
TYPES OF FAULTY POSTURES. 
The faulty postures occurring in the anteroposterior plane 
of the body comprise those defects commonly designated 
as “round shoulders.” This term, however, is a narrow 
one if interpreted to mean only the incorrect position of 54 
ANTERO-POSTERIOR FAULTY POSTURES 
the shoulders, for this is but one feature of the condition. 
Its correction involves the consideration of all the body 
segments, from feet to head, and of their interrelation and 
adjustment to the center of gravity. Therefore, the name 
“anteroposterior faulty postures” is much more inclusive. 
Types within this designation vary; in fact, they differ 
almost as much as the individuals who exhibit them. For 
convenience of study, and for ease in planning exercise for 
their correction, they will be classified as nearly as possible 
into certain rather definite groups. 
The terms kyphosis and lordosis are in frequent use in 
reference to faulty posture, and may be defined as follows: 
Kyphosis. Increase of the normal physiological curve in 
the thoracic region. 
Lordosis. Increase of the normal physiological curve in 
the lumbar region. 
Stoop Shoulders.—This is a condition in which the main 
difficulty is the forward projection of the head, sometimes 
involving the upper thoracic as well as the cervical region. 
The seventh cervical vertebra is usually prominent. Stoop- 
shoulders, as a state, is accompanied by a flat chest, with 
hollows under the clavicles, but there is little or no change 
in the mid-dorsal and lumbar regions of the spine. 
Round Back.—In this type the entire back is relaxed; the 
rounding of the thoracic curve seems to encroach upon the 
lumbar region, almost obliterating the curve in that area. 
The weight of the body is also carried over the heels, the 
whole trunk settling back at the sacrolumbar junction. 
This type is sometimes called “sway-back.” This would 
be a condition of marked kyphosis (Fig. 10). 
Hollow Back (Lordosis).—The posture of the head and 
shoulders may not be affected, but the lumbar curve is exag- 
gerated and the inclination of the pelvis will be increased. 
Also the knees are usually hyperextended. TYPES OF FAULTY POSTURES 
55 
Round Hollow Back (Kypholordosis). - Perhaps this is 
the most common type of all, in which both kyphosis and 
lordosis are present. One curve seems to complement the 
Fia. 10.—Typical “kyphosis,” “round 
back,” or “sway-back.” 
Fio. 11.—Typical “round-hollow 
back.” 
other in an effort to reestablish the balance lost by the 
initial faulty position (Fig. 11). 
Flat Back.—In this type there is a lessening of all the 
physiological curves, especially the lumbar. It is a very 56 
ANTERO-POSTERIOR FAULTY POSTURES 
weak type of baek, and is accompanied by forward droop- 
ing of the shoulders and flattening of the chest. It is fre- 
quent in older women, and is apt to be attended by back- 
ache, because of the undue strain upon the muscles of the 
lower back, produced by the faulty bodily mechanics. 
With all these types there will be found maladjustments 
of the shoulders, chest, scapulae and abdomen. 
Shoulders and Chest.—The forward position of the shoul- 
ders is a noticeable feature in all antero-posterior types of 
faulty posture—the inward rotation of the humerus with 
the accompanying contraction of the pectoralis major and 
minor muscles, making one of the difficult problems of cor- 
rection. 
With the forward position of the shoulders will be found 
such conditions as the flat contracted chest, the hollow 
chest, depressions under the clavicles, recession of the 
sternum, and other maladjustments. 
Scapulae.—These may be prominent with the vertebral 
borders raised and drawn forward (the so-called “winged 
scapulae”). This condition shows the relaxation of the 
rhomboid and trapezius muscles with a resulting contraction 
of the pectoralis major and anterior portion of the deltoid. 
It sometimes happens in cases of this character, that the 
whole shoulder girdle is pulled downward and forward, 
resulting in the prominence of the inferior angles of the 
scapulae. When this takes place, the pectoralis minor, by its 
attachment to the coracoid process of the scapula, exerts too 
great a pull, especially when the posterior scapular muscles 
are relaxed. Undoubtedly, the forward pull of the serratus 
magnus is also a factor in the faulty position of the scapulae. 
Abdomen.—Muscular relaxation of the abdominal walls is 
frequently associated with this deformity of the back and a 
prominent abdomen is also a characteristic accompaniment. FLEXIBILITY OF THE MECHANISM 
57 
Inclination of the Pelvis.—This may be either increased 
or diminished. The correction of either defect should be 
regarded as fundamental in the treatment. 
The Feet and Knees.—The feet and knees are to be con- 
sidered also, as the position of the pelvis is materially affected 
by their placement. Pronated or weak feet and hyper- 
extended or flexed knees are often present. 
A series of conditions seemingly interrelated are as follows: 
1. Hyperextended knees causing increased inclination 
of the pelvis; this leading to lordosis. 
2. Flexed knees, causing decreased inclination of the 
pelvis, leading to obliteration of lumbar curve, and 
encouraging “ round back. ’ 
FLEXIBILITY OF THE MECHANISM. 
All types of faulty posture come under two groups in 
regard to general characteristics: 
1. The flexible, or non-resistant. 
2. The stiff, or resistant. 
In the flexible type it is possible for the individual, of his 
own effort, to assume a correct posture, although he may 
not know how to do it, because muscular coordinations have 
been lost by the repeated assumption of the faulty position. 
A child will frequently say that he “feels crooked” when 
placed in a straight position by the teacher, as the faulty 
attitude has become habitual and feels “natural.” 
The treatment of the flexible type, therefore, resolves 
itself into a reeducation of the muscle sense, and the strength- 
ening of the muscles to make it possible to hold the correct 
posture. 
In the stiff or resistant type, incorrect positions have pre- 
vailed for so long that adaptive changes, sometimes very 58 
ANTERO-POSTERIOR FAULTY POSTURES 
marked, have taken place in the tissues. In spite of the 
effort to correct the posture, the individual is frequently 
physically unable to do so, and in pronounced conditions of 
extreme stiffness, even the teacher may be unable forcibly 
to bring the body into correct position. 
Under these extreme conditions the problem of correction 
is much more difficult and complex. The contracted tissues 
must not only be stretched until a flexibility nearer normal 
is obtained, but the muscles must be trained until new 
coordinations are established. 
Individuals, by nature, vary as to type; some are stiff, 
“stocky,” or in many instances are muscle-bound. They do 
not, or cannot, fully and easily extend their joints. Others 
are loose-jointed or “floppy.” Their joints are not only 
well extended, but hyperextended, and they have almost 
too great flexibility. With the ability to assume good 
posture, they can just as readily lose it again, because of 
their extreme flexibility. The strong, determined mind 
and the floppy, irresponsible mind are usually concomitants 
and factors in the difficult problem of correction. 
ETIOLOGY. 
Iii investigating the causes of faulty antero-posterior pos- 
tures, we find that they must be regarded as cumulative 
in character, and that the situation is one of considerable 
complexity, for it involves the consideration of conditions 
in the environment of the individual: the hygiene, surround- 
ings of daily life, habits of work and play, any or all of which 
may have a direct bearing upon the formation of incorrect 
habits of sitting or standing, that lead to more or less per- 
manent postural errors. 
It seems as if it ought not to be necessary to place such ETIOLOGY 
59 
great stress upon the maintenance of good posture. It 
should come naturally to the majority of individuals to 
hold the body easily erect, but it is a very evident fact that 
this is not the case. Primitive man and savages, living 
a free, out-of-door life, unhampered by clothing and other 
restrictions of civilization, have no trouble about posture. 
It comes naturally, as the by-product of healthy living and 
proper bodily activity. But “man has become a standing- 
around, and a sitting-down animal, rather than a running- 
around one,” and is subject to an artificial environment to 
which the body adapts itself automatically, and the evil 
influences of which must be counteracted by artificial means. 
Nearly all the activities of daily life encourage the forward 
position of the arms and head; sedentary occupations per- 
mit the relaxation of the anterior musculature of the trunk, 
and the tendency of gravity is ever to pull forward and 
downward. 
Muscular Weakness.—Muscular weakness is an important 
factor in the causation of these conditions. The period of 
rapid growth and development of the child is particularly 
critical, for, many times the bony structures grow faster 
than the muscles, which, therefore, are without sufficient 
strength to support the skeleton in a normal position. Some- 
times this lack of muscular tone is occasioned by improper 
nourishment, the food being insufficient in nutrient qualities, 
or the power of assimilation may be poor. In either case 
both soft bones and flabby tissues may result 
The above mentioned conditions are found in all classes 
of society, and are not confined to the children of the poor. 
It is too often the case that the young are pampered as to 
their appetites, and are allowed to eat all sorts of food, irre- 
spective of its nutritional value. The digestive apparatus 
suffers thereby, and the result is a depleted condition. Weak 60 
ANTERO-POSTERIOR FAULTY POSTURES 
muscle tone also follows illness, with a consequent tendency 
to the formation of poor habits of posture. The presence 
of adenoids, causing improper breathing has a distinct bear- 
ing upon health, and this, as well as any abnormality or con- 
dition afTecting the general hygiene of the individual, lowers 
the strength and may indirectly lead to postural errors or 
permanent deformity. 
Many children, especially those of the cities, obtain far 
too little exercise. They have no opportunity for that free 
play that makes for a strong physique. Crowded streets 
and close quarters do not permit proper sports and there 
are other demands on their time. Great numbers of children 
are riding about in automobiles, sitting with inert muscles, 
when they might be getting healthful activity by running and 
walking, at least when going to and from school. After a 
day seated at the school desk, a child frequently exercises 
only by walking from the classroom to the waiting automo- 
bile, to be conveyed home for further indoor study. Even 
the beneficial exercise of stair-climbing is eliminated by 
elevators. 
Habitual Assumption of Faulty Positions.—This has an 
important bearing as a causative element. Certain occupa- 
tions or industrial pursuits necessitate prolonged sitting or 
standing in one position, day after day, as is the case in shops 
and factories where employees work at machines, or where 
girls are sewing, or are at the switchboards of telephones, 
etc. Typesetters are noted as having difficulty in pre- 
serving anything like a good posture, and are often found 
to be greatly below par physically. From investigations 
made by an efficiency expert it was found that poor venti- 
lation had a marked effect upon posture. 
Much is being done by many industrial companies to 
improve conditions and they are now paying more attention THE SCHOOL PROBLEM 
61 
to the importance of hygiene and good posture, and in many 
instances have organized classes in physical education and 
corrective gymnastics for their employees. From the point 
of view of the employer this is economy, as it results in 
increased efficiency and production. 
THE SCHOOL PROBLEM. 
Of all the occupations of the growing child, that of school 
is most universal in its bearing and of the greatest importance. 
So much of their time is spent by girls and boys in the school 
room, it would seem that the conditions there should be 
made ideal. On the contrary, many times the situation is 
quite the reverse. 
Not a few faulty postures are undoubtedly caused and 
fostered by improper seating, careless positions at the desks, 
and too prolonged periods of study. No amount of corrective 
work will be of lasting value unless such predisposing causes 
can be removed. Nearly all the tasks and lessons of the 
school child encourage the forward position of the head and 
arms, which in turn tends to draw the head and shoulders 
forward. The sedentary character of the work permitting 
the relaxation of the anterior musculature (notably the 
abdominal and waist muscles) also adds its influence. One 
writer observes that, “ From the third year up most school 
children sit at least 80 per cent of the school day, or more 
than four hours out of five.”1 Even if a child were sitting 
in a good position in a well-fitted chair—a condition that 
constitutes the exception rather than the rule—the effect 
would be pernicious enough because of the weakening of the 
muscles from inactivity. 
1 Bancroft: The Posture of School Children. 62 
ANTERO-POSTERIOR FAULTY POSTURES 
Again, the fatigue and consequent mental weariness, 
engendered by school requirements, anxiety over lessons, 
the concentration necessary for the performance of difficult 
tasks, produces actual changes in the metabolism of the 
body, lowers the vitality and likewise its resistance. In 
addition this is frequently augmented by improperly ven- 
Fig. 12.—Good position at school desk for reading, 
tilated school rooms. A “vicious circle” is soon formed— 
poor posture—lowered vitality, and this in turn reacting 
still further on the posture. 
Fatigue Postures.—The resultant poor postures have been 
recognized so generally that the name “fatigue postures” 
has been applied to them. Such conditions are found among 
pupils of all grades, and even among college students similar THE SCHOOL PROBLEM 
63 
situations are present. Because of the necessity for con- 
centration upon the required lesson and of taking notes 
rapidly, the mind cannot be diverted to the effort necessary 
for sitting erect while performing tasks that often tax endur- 
ance to the utmost. 
Fig. 13.—Poor position at school desk for reading 
Many teachers, whose attention has been called to these 
matters, are now devoting their efforts to improvement along 
the lines indicated. The best results cannot be expected 
unless based upon the cooperation of all who are respon- 
sible for the present hazards of school life. It would seem 
that there should be some readjustment of our educational 
systems whereby these problems could be minimized, if not 
solved, for education of the individual must embody the 
“Mens sana in eorpore sano.” 64 
ANTERO-POSTERIOR FAULTY POSTURES 
• If the positions assumed in the school room were of con- 
stantly varying character, it is doubtful if harm would 
result, for the restlessness of young children, the propensity 
which they show for frequent change of position, seems to 
protect them from habits of faulty posture. But the ten- 
Fig. 14.—Good position at school desk for writing. 
dency of the individual is to repeat the same thing over and 
over, and to adjust one’s self to the most advantageous and 
comfortable position, which is thereafter frequently or con- 
stantly assumed until it becomes a routine or fixed habit. 
The marked increase in faulty posture, as soon as a child 
begins to go to school, leads to the conclusion that the school THE SCHOOL PROBLEM 
65 
is responsible in a large degree, since it hampers the normal 
activity of the body. 
Adjustment of School Seats and Desks.—It is important to 
have seats and desks adjusted carefully to each individual, 
and to have this attended to not only at the beginning of 
the year, but during the term as well, thus allowing for the 
Fig. 15.—Poor position at school desk for writing. 
possibility of growth, and also for the probability that some 
part of the mechanism of the furniture may have slipped 
out of place. Although the adjustment should be simple, 
in many schools this is carelessly left to the janitor, who is 
often in a hurry, and does not appreciate the importance 
of his task. Perhaps the decision as to the height and size 
5 66 
ANTERO-POSTERIOR FAULTY POSTURES 
of the desk and seat is left to the child, or it may be arbitrarily 
adjusted without reference to the stature of the pupil. 
Furthermore, some furniture is difficult of adjustment, 
and so, while a school may be equipped with adjustable 
furniture, it does not follow that it is properly adjusted. 
The faulty adjustments between the desk and seat are 
of two sorts, viz.: 
1. The desk too high. 
2. The desk too low. 
With the desk too high the shoulders are elevated and the 
head and chest thrown into an awkward position. 
With the desk too low there is not sufficient room for the 
legs, and the tendency is to slide down into the seat so that 
the legs may be extended forward, then to allow the trunk 
to collapse forward toward the desk, resting the arms on it, 
thus bringing about a most undesirable position of the whole 
body. 
It is apparent, therefore, that of the two kinds of desks 
the one that is too low is the cause of more injurious con- 
ditions. 
If the chair is not of correct height, faulty adjustments 
also take place. There must be room for. the legs, other- 
wise, varieties of positions will be assumed involving twist- 
ing of the trunk, and one-sided postures may result. These 
will be discussed under the consideration of lateral cur- 
vature. 
In many instances it seems to be a case of adjusting the 
body of the individual to the furniture rather than of fitting 
the furniture to the individual. All the blame, however, 
should not be attributed to the faults of the furniture and 
its adjustment, for, even with the most ideal arrangement, 
attention should be directed to the correct way of sitting, 
and children be taught to sit as well as to stand properly. THE SCHOOL PROBLEM 
67 
Otherwise, slouchy attitudes will be probable. (Figs. 12 to 
15). 
The position of the hands and arms is important. Lean- 
ing forward, resting on one arm or on the elbows, should 
not be allowed. When sitting in a position of attention 
the arms should hang easily at the sides, with hands in the 
lap or on sides of the seat, or be loosely clasped on the edge 
of the desk. Folding the arms behind the back is undesir- 
able, as it allows the body to slide forward in the seat and 
increases the lumbar curve. 
Seats should be so adjusted that there will be no pressure 
under the knees upon the bloodvessels and nerves, and 
should, therefore, have a depth several inches less than the 
length of the thighs. The height of the seat should be such 
that the feet may rest easily upon the floor, with the ankle-, 
knee- and hip-joints bent at right angles. The seat should 
slope slightly downward, from front to back, and the back 
support be relatively low. 
Desks.—The height of the desk should be such that the 
forearm may rest easily upon it with the elbow bent at right 
angles and the shoulder neither elevated nor depressed. The 
most desirable slope for the desk has been found to be about 
15 degrees. 
It seems probable that the old style adjustable desk bids 
fair to be superseded by the more practical, comfortable 
and easily adjustable furniture worked out and placed on 
the market by the American Posture League. This type 
of furniture has many advantages. It is not fastened to the 
floor and thus can be arranged in better relation to the 
teacher, or can be removed easily. Books are kept in a 
drawer under the chair seat. The desk and seat are easily 
adjusted by means of screws which can be turned by hand 
and do not necessitate the use of tools. The seat is slightly 68 
ANTERO-POSTERIOR FAULTY POSTURES 
hollowed from front to back with an opening at the back for 
the buttocks. These seats are made in several sizes, and a 
factory chair is also made. 
Proper seating is not so much for the support of the spine 
as for the support of the pelvis, in order that its proper rela- 
tion to the spine may be maintained. It is possible to sit 
poorly in the best adjusted seat or to sit fairly well in a poor 
seat. Much depends upon the individual effort and the 
importance that one attaches to the matter. 
The value of teaching the fundamental principles of sitting 
correctly in any sort of chair is evident from the fact that 
most of the furniture used in our daily avocations is not 
adjusted to our needs. “Sitting down” is quite expressive 
of the usual method: the body segments collapse, the hips 
slide forward in the chair, the back is bent like a bow, and 
the muscles of the trunk relax. Why not “sit up” instead: 
the feet resting on the floor, the hips pushed back in the 
chair as far as possible, thereby making a firm point of 
support for the spine, with the body held erect and easily 
poised by the tonic contraction of the supporting muscles. 
Writing Position.—The old method of slanting writing, and 
the manner of sitting thus made necessary, was undoubtedly 
productive of a certain amount of incorrect posture. In most 
schools the system of writing now in use requires the child 
to sit squarely at the desk, feet on the floor, arms resting on 
the desk, elbows bent at right angles. The left hand guides 
the paper, and the direction is given to write, making the 
movements on the “fat muscle” of the arm, “in and out of 
the sleeve.” There is, in this position, no necessity for turn- 
ing the head, as the writing is plainly visible, and a writing 
lesson may be made an excellent opportunity for the practice 
of good, sitting posture. Care should be taken to prevent 
leaning forward heavily on the arms, and a crouching posi- 
tion avoided. THE SCHOOL PROBLEM 
69 
Defective Eyesight and Hearing.—These may contribute 
their quota to a faulty posture. An individual who has 
defective vision will lean forward in the effort to see the 
work or the blackboard, and the same effort will be made if 
the hearing is impaired. If a persistent tendency is shown 
to push the head forward or to round the shoulders, it should 
arouse suspicion in the mind of the teacher, and the vision 
and hearing should be tested. In this connection the light- 
ing of the school room is important. There should be no 
dark corners. 
Carrying Books to and from School presents one of the 
greatest of the school problems with which we must deal. 
Children often carry five or six pounds of books daily, some- 
times for necessary study, and sometimes, because in our 
congested schools, where two sets of classes are in session 
daily, there is no safe place for the pupil to leave books. 
In many of the schools, lockers are being provided, so this 
need will be met. Books are carried in every conceivable 
way: in a bag over the shoulder, in a case, on one hip, 
under the arm, etc. Each individual adopts a method, 
and then is liable to form a routine or fixed habit. The 
best arrangement for meeting this difficulty, but one which 
does find much favor, is to use a bag like a knapsack, with 
straps over both shoulders; the next best is for the child 
to carry books on alternate days first on one side, then on 
the other. Two sets of books, one at home and one at school, 
would solve the problem. 
The Teacher’s Posture.—As the force of example is great, 
the teacher needs to appreciate the significance of the 
posture and appearance which she presents before the 
class. The young are quick to imitate, not alone desirable 
qualities, but often peculiarities of dress and manner, or 
the attitude of instructors whom they observe. It behooves 70 
ANTERO-POSTERIOR FAULTY POSTURES 
those who occupy such positions, to consider their respon- 
sibility in setting high standards, which is an important 
part of their educational program. Children are severe 
critics, and frequently one may hear a child say, with an 
accompanying illustration of the posture observed, “ You 
ought to see my teacher; she stands this way!” 
Teachers, especially those of physical education, should 
embody in themselves the mental and physical poise which 
they strive to impart, otherwise their teaching will not be 
effective. The reaction upon a class of the teacher’s mental 
state, as expressed in terms of posture, is too important to 
be ignored. A depressed mental state at once produces a 
tendency to relax the whole body. This depression and 
relaxation is transmitted to the individuals in the class, and 
the inspiration to effort is lost. The stimulating influence 
of a teacher with an erect bearing and enthusiastic manner 
cannot be overestimated. 
THE PARENTS’ RESPONSIBILITY. 
While the schools and teachers have responsibilities to 
bear in regard to the child, that of the parent is greatest 
of all, and often is the one least appreciated and assumed. 
Many parents are ignorant in regard to the faults to which 
children are susceptible while growing, the predisposing 
causes and the influence of home surroundings. It usually 
lies in the power of the parent to exercise such preventive 
measures that the corrective need will be reduced to a 
minimum. 
The first parental duty is to provide general hygiene: 
proper food, plenty of fresh air, sufficient sleep on a low 
pillow in a well-ventilated room, and time for recreation. 
Many parents attend conscientiously to these and other THE PARENTS’ RESPONSIBILITY 
71 
details, but are not awake to other equally important factors 
in the every-day environment of the child which may have a 
bearing upon the proper growth and development. They 
often complain despairingly, for example, that their children 
sit at the table in atrocious postures, without ever having 
given any intelligent thought to the possibility that the 
chair seat is not high enough for the child to reach the table 
comfortably or that the feet are unsupported and the legs 
dangling. Correct seating for study and for piano practice 
is often overlooked. Attention should also be given to the 
arrangement of light for study and reading. 
Clothing.—The influence which clothing may exert upon 
posture is a subject to which the attention of the parent 
should be directed. The underwaists worn by many 
children are supported by straps which pass over the outer 
point of the shoulder and the head of the humerus, which 
is movable. The garters are attached below, in front, so 
that there is then exerted an elastic downward drag, so 
strong, that many times the child is unable or unwilling to 
make the muscular effort necessary to counteract the 
tendency to the forward pull, and a stooped attitude results 
(Fig. 16). There are waists now on the market which 
obviate this feature, by having shoulder straps placed so 
that the pull comes over the shoulder girdle, higher up on 
the neck, and the shoulder-joint is left free. 
It is of noteworthy interest to learn from the experience 
of both children and parents, that the ability to stand up 
better exists when socks are worn, for the child is thereby 
relieved of the garter pull. It would surprise one, who has 
not had attention called to the matter, to observe the 
amount of tension that can usually be found in the elastic 
of the garters, which means a constant downward pull on 
the shoulders. 72 
ANTERO-POSTERIOR FAULTY POSTURES 
The development of the bust in growing girls may have 
a distinct influence upon posture. Sometimes the increased 
weight of the breasts is sufficient to draw the shoulder girdle 
forward and downward, or to increase a forward tendency 
already established. More often, however, adolescent psy- 
chology is at the root of the difficulty. Many girls at this 
time are supersensitive and consider this normal growth 
a cause for embarrassment. There is a desire for conceal- 
ment and a relaxed posture of the arms and shoulders is 
cultivated for the purpose. Added to this, fashion dictates 
the “flat, boyish figure,” and a tight brassiere is worn, 
most pernicious in effect, retarding development and causing 
the busts to become flabby and pendulous. The solution 
of this problem should give mothers and teachers food 
for earnest thought. 
With girls, the arrangement of hair may constitute a con- 
tributory factor necessary to be considered in combating 
faulty posture. If there is a tendency to a forward position 
of the head, the effect of a bunch of hair held at the neck 
by a large ribbon is to push it forward still farther. The 
weight of a heavy mass of hair will produce the same result. 
Also caps, as worn by children in winter, pulled over the 
back of the neck and ears, or high collars on coats and 
sweaters, may have a similar effect. It takes only a slight 
suggestion to help in the formation of a habit, and several 
such suggestions form an aggregate which can exert con- 
siderable influence. 
Again, boys’ coats should not be too heavy. In one school 
a plan for having the boys remove their coats in warm 
weather resulted in improvement of posture. The investiga- 
tions of the Posture League have brought out, in this con- 
nection, this most interesting point: that the majority of 
men’s and boy’s coats are made to fit over a display model THE PARENTS’ RESPONSIBILITY 
73 
which is faulty as to the position of head and shoulders. 
Wearing such a garment actually induces poor posture, 
because if an erect position is assumed the coat wrinkles 
across the shoulders. 
Fig. 16.—Type of underwaist worn by many children, exerting a strong 
forward pull on the shoulders. 
Fashion.—The effect that fashion may have upon the 
voluntary assumption of certain postures is considerable. 
Impressionable girls see beauty in illustrations in the fashion 
papers, or—if we may use the expression—in a sort of 
“hero worship’’ strive to imitate society or stage favorites. 
The “debutante slouch’’ was an influence hard to overcome 
and sometimes became the despair of the teacher who under- 74 
ANTERO-POSTERIOR FAULTY POSTURES 
took to set up other standards which were not considered 
fashionable. 
The young man also often sets up poor standards. A 
“slouch,” for instance, is considered manly, and is often 
assiduously cultivated. The habit, also, of carrying the 
hands in the pockets has been universally recognized as 
having a tendency to promote an undesirable posture. 
Shoes.—Shoes which are uncomfortable or ill-fitting are 
among contributory causes of the faults under consideration. 
Weak feet and misshaped shoes which afford inadequate or 
unequal support to the body, thereby promote faulty posture 
to say nothing of the extreme discomfort endured. The shoe 
with the high heel and pointed toe necessitates an entire 
readjustment of the segments of the body which are super- 
imposed upon the foot and produces some of the most 
unsightly postures. Alteration in the position of the base 
of support, the foot, from horizontal to slanting, which 
necessarily results from wearing the high heel, disturbs 
the center of gravity, changes the weight distribution, 
throws the body forward, tending to hex the knee, and other 
adjustments must follow in the altered positions of the pelvis 
and spine. One of the most common of the deformities pro- 
duced is lordosis.1 
Above all, the parent can make sure of conditions and 
tendencies in no better way than by a periodic examination 
of the child undressed, and although this should be part 
of the established routine, nevertheless it is rarely done. 
Seeing an individual regularly, day after day, in clothing, 
the eye does not appreciate defects until they become 
fairly pronounced. There is no garment which more 
effectually disguises the lines of the figure than the “ middy 
1 This subject is discussed more fully in the chapter on the Feet. THE PARENTS’ RESPONSIBILITY 
75 
blouse,” so universally worn, falling in a straight line from 
the neck. 
Fig. 17.—A condition concealed by the disguising “middy blouse” and 
arrangement of the hair. 
In addition, a girl’s hair arrangement is often such as to 
complete the delusion of a good posture, by filling in the 
back of the neck, so that the casual observer thinks the 76 
ANTERO-POSTERIOR FAULTY POSTURES 
child quite erect, and the astonishment of parents is fre- 
quently great, when clothing is removed, and attention is 
called to the actual condition (Fig. 17). 
There is no doubt that the youth of today is very much 
overtaxed, not alone by the duties of school and home 
study, which leave too little time for play and healthful 
activities, but also by the demands of present-day civili- 
zation. It does not seem fair that the requirements should 
be so great at the critical period of growth and development 
as to tax physical and mental powers to the utmost. In 
view of these exactions, how can we blame them so much 
for faulty posture? Consider for a moment the following 
schedule: School and home lessons, music lessons, possibly 
one or two foreign languages to be acquired, dancing school, 
frequent visits to the dentist for the tedious process of hav- 
ing teeth straightened, and, it may be, one or two lessons a 
week in individual gymnastics. This is not an extreme 
picture, but one which in the experience of the writer is 
not at all uncommon or overdrawn. It is the duty of the 
parent to take this question very much to heart, and to 
simplify life as much as possible for these growing and 
developing children. Let them not be too ambitious for 
prowess and achievement, gained, too often, at a sacrifice of 
health and strength. 
As posture is influenced to a great extent by low vitality 
and fatigue, then, if the demands upon the young can be 
lessened, and more time be given to free play and recrea- 
tion, the general condition will be improved and we have 
established a foundation upon which to build an efficient 
mechanism, one which shall “raise the mean” for the next 
generation, and good posture will come as its natural 
sequence or result. CHAPTER VI. 
EXAMINATION—RECORDS—THE SCHEMATO- 
GRAPH-TREATMENT-POSTURE 
DRIYES-POSTERS. 
METHOD OF EXAMINATION OF ANTERO-POSTERIOR 
FAULTY FOSTURES. 
Preparation of the Pupil.—The pupil should be entirely 
undressed when possible. At the least, so much of the 
clothing should be removed that the trunk will be exposed 
to the level of the great trochanters, in order that the line 
of the hips and the gluteal fold may be revealed. Otherwise 
it is impossible to observe the relationship of the parts of 
the body to one another or to make any examination other 
than a most superficial one, that is liable to lead to an erro- 
neous diagnosis. 
The hair, if long, ought to be so arranged that the lines of 
the neck are observable. 
There should be no clothing or bands around the waist. 
The shoes should be removed. 
The pupil should stand with the weight on both feet, arms 
hanging at the sides of the body, and exposed to a strong 
light falling in such a manner that the shadows are equal. 
The teacher’s manner should be quiet, business-like, and 
such as will put the person who is being examined at ease. 
The creation of a matter-of-fact atmosphere is requisite. 
Marked comments upon the result of the examination, in 
the presence and hearing of the pupil are far from advisable 78 
EXAMINATION 
from any point of view, in fact, such comments are most 
objectionable. 
Since embarrassment and nervousness may cause exagger- 
ated positions to be assumed, it is well to allow the pupil to 
stand quietly for a moment or two, observing the position 
carefully, meanwhile, until it becomes relaxed. There 
should be as little handling as possible, as this tends to pro- 
duce nervous reactions and self-consciousness. The examina- 
tion should be conducted quickly, though not hurriedly, in 
order to avoid fatigue. 
During the examination use, if possible, some kind of a 
garment which is simple and may be easily laundered. For 
this purpose we would suggest taking merely a long strip of 
outing flannel, making a slit about a foot long, cut length- 
wise through the center for the head. This covers the 
body sufficiently and can be easily adjusted for the exami- 
nation of any part of the trunk. 
Points to be Noted in Examination. — The examination 
should be made from the front, from the back, and from the 
side, so that the body may be seen in all its aspects and the 
following conditions noted: 
1. General hygiene and muscle tone. 
2. Feet: Any abnormalities—strength of arches. 
3. Knees: Hyperextended or flexed. 
4. Abdomen: Relaxed—prominent, or otherwise abnor- 
mal. 
5. Chest: Flat, narrow, depressed, or otherwise abnormal. 
6. Shoulders: Position. 
7. Scapulse: Prominence—position. 
8. Position of head. 
9. Exaggeration of normal physiological curves (kyphosis 
—lordosis). 
10. Type: Stiff—flexible. ANTERO-POSTERIOR FAULTY POSTURES 
79 
11. Posture, estimated by the above data and by observa- 
tion of the weight-distribution as indicated by the deviation 
of the body segments from the straight line axis. Diagram 
(Fig. 18). 
A method of estimating posture quickly, and one which 
is of value in the school room where numbers fully dressed 
must be dealt with, is the “window-pole test.’’1 Appre- 
ciating the fact that the axes of the body segments should 
form a series of straight lines, if a straight object such as a 
window-pole is interposed between the eye and the posture 
to be judged, comparison can be made quickly. While this 
test does not take the place of the detailed examination, it is 
helpful, makes a basis for grading posture in the school room, 
and arouses the interest of the pupil. 
Methods of Measuring and Recording.—These methods are 
various and of relative value. From time to time, mechani- 
cal devices have been invented, many of them good, but the 
principal objections have been that they were either too 
expensive to be generally adopted, or were so complicated 
of adjustment as to fatigue both the pupil and the observer. 
Measurements taken on the skin with a tape-measure are 
unsatisfactory, because the skin moves so readily over the 
underlying bony structures. The inability to hold the 
body steady, and the difficulty of reproducing with exactness 
the same conditions as at a previous examination, add 
other elements of inaccuracy in records derived from the 
use of the tape-measure. These considerations have forced 
the conclusion upon most of those interested in the subject, 
that some general picture of the condition, is of greater 
value than a series of measurements in terms of inches. 
Tracings of the figure by means of the pantograph have 
been used to some extent. 
1 Bancroft: The Posture of School Children. 80 
EXAMINATION 
Another method in use by some, is to obtain contours of 
the back by means of a flexible lead tape, and this, outlined 
on cardboard, serves as a record, subsequent drawings being 
superimposed and improvement noted. 
Method of Grading Posture.—It would be helpful if posture 
could be graded on a percentage basis, especially as an incen- 
tive to the pupil, to whom the points of deficiency would 
thus become more tangible. On the assumption that 
postures fall into four groups as regards degree (A, B, C, I)) 
—deficiencies noted in the examination may be estimated 
by the teacher in terms of grades, points or percentages. 
This grading would be, at best, only relative, as any mark- 
ing of this sort is influenced by the standard set by the 
individual teacher. 
A method, strictly empirical, being tried by the author, 
is given herewith. Assuming A =20 points =100 per cent, 
credits are as follows: 
Head 3 points 
Chest 3 “ 
Dorsal curve 3 “ 
Lumbar 3 “ 
Abdomen 3 “ 
Weight-distribution 5 “ 
20 points ANTERO-POSTERIOR FAULTY POSTURES 
81 
The following diagram is self-explanatory. (Fig. 18.) 
Fig. 18. 
Grades A 
A- 
B + 
B 
B- 
c + 
C C- 
D + 
D 
D- 
Points 20 
19 
18 
17 
16 
15 
14 13 
12 
11 
10 
Percentage 100 
95 
90 
85 
80 
75 
70 ' 65 
60 
55 
50 
Photography.—Photography, is perhaps, the best means of 
showing the existing condition, but it has not been generally 
used except in special cases, for the reason that the difficulty 
exists, not only of overcoming embarrassment, but also of 
the identification of the individual and of expense. 82 
EXAMINATION 
The Schematograph.—The schematograph is an apparatus 
invented by I)r. Cleila Mosher and Professor Lesley, of 
the Leland Stanford Junior University, California. As its 
name implies, it is for drawing the form, and has been 
employed with much success as a quick, graphic method of 
recording outlines of the figure. In appearance, this instru- 
ment is much like a camera with a focusing lens. It has 
Fig. 19.—The schematograph. 
an arrangement of mirrors by which an image is thrown 
upon a sheet of clear glass, on which is superimposed a piece 
of tracing paper. The manner of using this apparatus may 
be briefly described as follows: 
The pupil stands about ten feet distant, against a dark 
background, and in a bright light. As originally planned, 
the apparatus and operator were to be in a dark room, such ANTERO-POSTERIOR FAULTY POSTURES 
83 
as a closet, with a hole in the door, through which the lens 
protruded. This arrangement is desirable for its mental 
effect on the pupil, who feels less under observation, and 
consequently stands more at ease. As a substitute for 
the dark room, a folding screen may be used, enclosing the 
schematograph on three sides, a hole cut in the center fold 
for the lens. The operator then stands behind with a black 
cloth thrown over the top of the screen and head. This 
arrangement has answered admirably. The image thrown 
on the tracing paper is then outlined with a soft pencil. In 
a short time, quite a knack is acquired in holding the hand 
steady, and in making the drawing, or “schematogram,” 
quickly and accurately (Fig. 19). 
There are several features which recommend the schemat- 
ograph for the purpose above stated; the pictures are inex- 
pensive (only a few cents each); the personal reserve of the 
pupil is maintained, and while the individuality of the face 
is eliminated, defects of posture are recorded. 
This apparatus is useful for the purpose of making routine 
measurements of large groups of individuals, as in a college, 
as by this means, a record of the posture can be added to the 
physical register of each student. The drawing can be made 
in two or three minutes. Again, as a means of arousing 
interest in the individual and as a stimulus to effort towrard 
improvement, this invention has been found excellent, for 
the student can be given, as a guide, a duplicate copy, which 
can be made in a moment, with indications or markings 
thereon, showing where improvements are desirable. From 
time to time the record is taken again and comparisons made. 
The criticism has been advanced that this record is not 
accurate. It is not claimed to be exact, as it must be sub- 
ject alwrays to the personal equation of twro people. Yet, 
as a general picture of the individual, it becomes a useful 
addition to our records. 
The prevalence of poor posture among college students is 84 
EXAMINATION 
Fig. 20.—Sehematograph records of posture, showing improvement in six 
months. ANTERO-POSTERIOR FAULTY POSTURES 
85 
quite generally recognized and its correction one of the prob- 
lems that besets the teacher of physical education. By the 
Fig. 21.—The possibilities of the schematograph for purposes of illustration. 
1 and 2, dancing postures; 3, an exercise; 4, 5 and 6, sitting postures. 
use of the schematograph, it has been possible to obtain 
numbers of drawings for study, from which deductions have 
been made (Fig. 20). Interesting studies in clothing can be 86 
EXAMINATION 
made also, and the possibilities of the use of the schemato- 
graph by the teacher for illustrative purposes are many 
(Fig. 21). 
It has been found that faults of posture exist among men 
as well as among women students. Dr. Lloyd T. Brown, 
in his study of over seven hundred men at Harvard College, 
says that “80 per cent of the group stood in either the C or 
I) class of posture, while only 20 per cent of this selected 
group of educated men stood with their bodies in a normal 
or nearly normal position.”1 
Studies made by the writer of a corresponding group of 
college women were surprising in the similarity of results, 
as the percentages of faulty postures were practically the 
same and the prevailing type almost identical. This is the 
type familiar to all where the weight of the body rests on the 
heels, the abdomen is prominent, the shoulders round—the 
“ slouch.” 
There is little doubt that the relation between faulty 
posture and health is very close. Among the women 
examined constipation was almost universal, menstrual 
pain and irregularity of frequent occurrence, and in most 
cases there was a falling below par of the general physical 
condition. Records showing improvement in these con- 
ditions after exercises had been taken for correction of 
posture, would seem to offer conclusive proof that these 
ills could be attributed to faulty bodily mechanics. 
TREATMENT. 
The lines along which it is essential to work for the improve- 
ment of these conditions are as follows: 
1. The removal of predisposing causes. 
1 Brown, L. T.: A Combined Medical and Postural Examination of 746 
Young Adults. TREATMENT 
87 
2. The establishment of good hygiene. 
3. “Mental set” of the pupil (a desire to improve and 
determination to persevere). 
4. Exercises. 
The Removal of Predisposing Causes.—This necessitates a 
careful survey of the environment of the individual; an 
inspection of the clothing and its adjustment, observation 
of habits of work and play, and investigation of postures 
in standing, sitting and sleeping. This should be followed 
by helpful suggestions. 
With young children, the attention of parents should be 
called to the importance of these matters, and their co- 
operation enlisted. The investigation of school conditions 
should be made also. Many parents need enlightenment, 
and should understand from the outset that it is not suffi- 
cient for the child to be sent to a teacher for special exercises 
once or twice a week. It is too often the case that the teacher 
is expected to perform miracles when the exercises oftentimes 
are the least part of the program of correction and only 
supplement the more important efforts for which the parent 
is responsible. When it is appreciated that the home-train- 
ing of the child should emphasize the proper carriage of 
the body in standing and sitting, and that insistence upon 
this is as important to the hygiene and welfare as the care 
of the teeth and the daily bath, then we shall have taken 
a long forward step in preventive measures. As “ preventive 
medicine” is superseding what may be designated as “cor- 
rective medicine,” is it too much to hope that the time is 
at hand when such measures may be taken in the prevention 
of the formation of faulty posture habits, that the necessity 
for corrective treatment will be reduced to a minimum? 
Good Hygiene.—This is essential in order that the organism 
may be in the best condition possible, that the muscles may 88 
EXAMINATION 
be strong enough to support the structures in their correct 
interrelation, that there shall be no undue fatigue, and that 
there is an abundance of energy and vitality. Frequently 
the establishment of improved hygiene is all that is necessary 
in treatment. Attention should be directed toward the 
healthy functioning of organs, and advice given in regard to 
food, exercise, elimination, and sleep. One authority says 
that “ten hours sleep should be insisted on in treatment.” 
The Mental Attitude.— This is a dominant note in the 
treatment. It has been mentioned previously that unless 
an individual desires to improve, is willing to make a dis- 
tinct and persistent effort, little result can be expected. 
The teacher has no power of “laying on of hands” by which 
it is possible to effect a cure, no matter how greatly such 
a gift is desired. It must come through the conscious effort 
of the individual. The teacher can but show the way and 
use ingenuity to awTaken interest and stimulate effort. 
Having removed causes, as far as possible, and established 
a better hygiene for a pupil who is earnest and interested, 
we may, with advantage, proceed with the treatment by 
exercises. 
Exercises.—The first consideration in planning a program 
of exercises is of the type of case, whether stiff or flexible. 
In the former condition, exercises should be given to stretch 
contracted tissues, thereby restoring more normal flexibility. 
In extreme conditions, passive exercises will be effective and 
necessary. After this the improvement of muscle tone and 
reeducation of the muscle sense follow. 
With the flexible type, no time need be spent in giving 
exercises to increase flexibility; in fact, care should be taken 
to select exercises that will not produce the overstretching 
of muscles already relaxed. A case in point would be the 
routine use of the exercise known as “ hanging from the bar,” METHODS OF STIMULATING INTEREST IN POSTURE 
89 
excellent for a stiff back, but ill-advised if used for a flexible 
one. 
Much of the work is in training the sense of position, for 
the problem is practically solved when a pupil learns how to 
make the adjustments necessary to obtain the correct posi- 
tion, and perseveres in this effort until the muscles become 
strengthened and the position can be held permanently. 
The best exercise for posture is the unremitting assumption 
of correct posture. 
Braces are worn sometimes but are not advisable in the 
majority of cases. The individual sinks into the brace and 
relies on it to do the work of the muscles, which consequently 
become weakened and still less able to hold the body upright. 
If a brace is worn it should be merely supplementary to the 
gymnastic treatment and be used only at such times as it is 
probable that poor positions will be assumed, as in school. 
Braces are difficult of adjustment and many of the ready- 
made ones sold in stores and advertised in glowing terms, 
do more harm than good and should be avoided. They may 
correct one fault while producing another which is as bad 
if not worse than the first. Many of them cause lordosis. 
In case a brace is thought necessary it should be made to 
individual measurement by an expert, preferably under the 
direction of an orthopaedic surgeon. 
METHODS OF STIMULATING INTEREST IN POSTURE. 
Recognizing that good posture is of far-reaching impor- 
tance, and that its acquirement should be basic in any 
educational program, the teacher of physical education is 
confronted with the problem of selecting the means to be 
employed in arousing among pupils of all grades in schools 
and colleges an effective interest in the subject. Unless 90 
EXAMINATION 
incentives to systematic effort are found, satisfactory results 
cannot be obtained. In reference to the importance of 
interest accompanied by effort it has been said: “It is only 
when they help each other that our work reaches perfection. 
To be interested without effort is to be entertained, to float 
with the current; to exert effort without interest is to be 
wearied, to row against the current; but to be interested 
with effort is to enjoy what is being accomplished, is to be 
steering for my destination while the current favors my 
progress.”1 As the methods must vary to fit conditions and 
ages, there is scope for considerable ingenuity. Some of the 
schemes which have been tried out and found of value will 
be outlined. 
It is always wise to give simple instruction to any group 
and present the subject in such a logical way that good pos- 
ture will appear as a thing desirable and not compulsory. 
Pictures and posters may be shown to illustrate good and 
poor postures, and deductions may be drawn by the pupils 
as well as by the teacher. The former should be encouraged 
to criticize freely, but always in a friendly spirit, the postures 
of their companions. Popular talks illustrated by a stereop- 
ticon can be made interesting to any group. It is fairly easy 
to have slides made, or they can be hired at a nominal 
expense.2 
In the elementary schools a method originated by Miss 
Bancroft has been used successfully. In this posture is made 
a subject of individual, class and school pride. Based on 
the “triple posture test” the class is divided into Group I, 
Good Posture; Group II, Poor Posture. Grades are given 
and names are written on the board. The incentive is for 
1 Prof. Horne: Philosophy of Education. 
2 American Posture League, 1 Madison Avenue, New York City; National 
Board, Y. W. C. A., 600 Lexington Avenue, New York City. Lantern slides 
can be hired from both organizations. METHODS OF STIMULATING INTEREST IN POSTURE 
91 
Group I individuals to keep up their standard, and for 
Group II individuals to be promoted as soon as possible. 
This scheme is carried still further by competition between 
(lasses, and finally becomes a school honor as well. Similar 
methods are being tried out in many schools by a system of 
reward—marks or badges of honor are given, and in one 
educational institution where colored “chevrons” were 
awarded, the effort made was astonishing. 
In most colleges it is now the custom to make good posture 
one of the requirements for eligibility to membership in 
the athletic teams. Students in some of the New York 
high schools and in the training school for teachers, have 
been given demerits for falling below the standard, and spe- 
cial work has been required until the posture mark was 
raised, before graduation was allowed. 
A pin has been designed by the Posture League which can 
be purchased and awarded provided certain requirements 
are fulfilled. 
With older college girls the problem has been met in a 
rather satisfactory way by a “posture drive,” calling atten- 
tion in emphatic ways to the subject. One of the most 
typical of these was carried out at Yassar College a short 
time ago. It is herewith described in full as being an excel- 
lent model.1 
The drive took place during the week before the spring 
holidays, being announced in the college paper in various 
interesting and amusing ways several times prior to the 
event: 
First Day. — Posture tests were given instead of the reg- 
ular lesson. 
Second Day.—Exhibition of posture posters. 
1 Originated and given by Miss Mary Catlin. Printed by permission. 92 
EXAMINATION 
Third Day.—1. Parade of students at noon, girls “slump- 
ing” badly and carrying posters visited every dining room 
and announced exhibits. 
2. Announcements in college paper, amusing poems, etc. 
3. Two “four-minute” speeches on the way to and from 
chapel, the girls chosen standing on soap boxes, and having 
been trained in public speaking, addressed the crowd of 
students on “posture” and “shoes.” 
Fourth Day.—Posture tag day. 
1. About forty students (girls who had passed the posture 
test previously and who stood and walked well) acted as 
Posture Policemen. They wore S. U. S. badges—Stand Up 
Straight—and it was their business to tag anyone who did 
not stand, walk or sit properly. Before the first class in the 
morning they lined up outside the recitation halls and made 
everyone walk between them. 
2. More posture tests were given in class. 
Fifth Day.—Each girl received a card in her mail box 
bearing the following inscription: 
IT IT S 
0TAND U P 0TRAIGHT 
Stick me in your mirror 
Or pin me on your door, 
If you live me, you will look 
Much better than before. 
Sixth Day. — Posture tests, and 
“Write up” in the college paper. 
During the drive, signs made by the girls were posted 
around the campus and in the dormitories. Many of these 
were “take-offs” of the titles of some of the popular plays, 
such as “the thirteenth chair,” for the girl with the hollow 
chest. “Redemption” of posture is what we want! Even METHODS OF STIMULATING INTEREST IN POSTURE 
93 
the crooked trees were admonished by placards to hold 
themselves straight. 
Each year some special effort is made to improve posture. 
A previous experiment was to appoint as a committee several 
of the students with good posture, each of whom observed 
for two weeks, without their knowledge, the postures of 
certain members of the class, averaged the marks and passed 
them to the instructor, on cards printed for the purpose. 
Name, 
Grade, 
A. Posture habitually correct. 
B. Posture “ fair. 
C. Posture “ poor. 
Date, Name of Judge, 
As appears in an earlier part of this chapter, the use of the 
schematograph has been found valuable as a means of 
creating individual interest. In the beginning, when this 
method was new, word passed from mouth to mouth among 
the students that a very unusual proceeding was taking 
place in connection with the regular measurements required 
by the college; soon the unusual phase passed to one of 
interest and each student became curious to see her own 
“graph/’ 
These drawings have the advantage of eliminating the 
personal element to such an extent that they can be shown 
and compared with freedom. The outline having been 
drawn, the teacher indicates to the student the conditions 
to be improved, such as the forward head; the rounded 
shoulders or flattened chest, making a few general sugges- 
tions, and drawing improved lines with a colored pencil on 
the original, a copy of which is given to the student for 
reflection and guidance. 
At a “posture week” recently the suggestion was made 
that it would be of interest to the general public to see the 94 
EXAMINATION 
schematographs of their postures. These were taken in 
clothing and the results were astonishing, as faults were 
revealed strikingly, and people were much impressed. From 
this the idea of a silhouette was evolved. A tracing of 
the schematogram was made on black silhouette paper 
(white on the reverse side), the outline was cut out and 
pasted on a white card, and a striking silhouette was pro- 
duced, taking only a few minutes to complete.1 
POSTERS. 
Posters may serve a two-fold purpose in directing atten- 
tion to the subject of posture: First, as a piece of research 
work for normal students in physical education, the making 
of a posture chart necessitates constructive thinking and 
gives scope for much originality. After instruction has been 
given on the subject of posture, each student is asked to 
design a poster which shall express in the most emphatic 
and striking way possible some central idea and not be just 
a collection of unrelated pictures of posture. It adds to the 
interest and calls attention to another subject of importance, 
to have some of the posters made with “feet and shoes” as 
the central motive. The interest becomes keen and the 
necessary search for pictures to illustrate ideas and for 
“slogans” which shall be appropriate and effective requires 
considerable thought. One does not need to be an artist in 
order to construct a poster, since pictures can be collected 
from various sources and utilized—for instance, newspaper 
illustrations have been made into some very striking ones. 
Posters are made on large sheets of cardboard of uniform 
size and color, furnished by the college, and are then placed 
1 Originated by Miss Emily Andrews, Central School of Hygiene and 
Physical Education, New York City. POSTERS 
95 
on exhibition. They are voted upon and marked by a com- 
mittee, and credit given, just t,he same as for any other 
required work. The exhibition is advertised, all departments 
of the college are invited, and undoubtedly their interest 
in the subject of posture will be thereby aroused also. 
Secondly, the posters may be used to illustrate lectures 
and for class-room propaganda, for various groups and on 
many occasions. 
Not only is the making of posters useful for college stu- 
dents, but this plan could be used to advantage in any 
school, from highest to lowest grades, and if made competi- 
tive would be of even greater interest. 
Rhymes and poems with appropriate allusions often 
catch the interest, as experience with “The Ode to Pos- 
ture” will show. This poem was circulated first among a 
small group of students, by one of whom it was composed. 
It has, however, gradually become widely known and during 
the past few months applications have been made for its 
use by more than one hundred schools, social and industrial 
organizations from all over the country. A most encourag- 
ing sign from the demand is, that it shows an universal effort 
to arouse interest in this vital subject (Fig. 22). 
In another instance, a Posture Week was designated as 
a “P. E. P.” drive. Interest was aroused in advance by 
posting the announcement, and a small prize was offered 
for the best interpretation of these letters. In this school 
“Posture Expresses Personality” received the greatest 
vote. 96 
EXAMINATION 
ODB to poszuke 
Good Posture is an asset 
Which very few possess; 
Sad to relate , the favored ones 
Seem to be growing less. 
We see the folkB around us 
All slumped down in a heap, 
And the way that people navigate 
Is enough to make you weep. 
Some elevate their shoulders, 
Some hollow in their backs, 
Some stiffen up their muscles, 
And some just plain relax. 
The one who walks with grace and poise 
Is a spectacle so rare, 
That even down on gay Broadway 
The people turn and stare. 
If you would cut a figure 
In business, sport, or school, 
Just mind the Posture precepts. 
Obey the Posture rule. 
Don't thrust your head out turtlewise; 
Don't hunch your shoulders so; 
Don't sag, and drag yourself around; 
No style to that, you know. 
Get uplift in your bearing, 
And strength and spring and vim; 
No matter what your worries, 
To slouch won't alter them. 
Just square your shoulders to the world, 
You're not the sort to quit, 
"It Isn't the load that breaks us down, 
It's the way we carry it'”. 
Fig. 22 CHAPTER VII. 
EXERCISES FOR THE CORRECTION OF FAULTY 
ANTERO-POSTERIOR POSTURE. 
The exercises given herewith have been selected from a 
large number as representative of the types used in planning 
programs for individual work. From these suggestions sup- 
plementary exercises can be added and programs planned 
to meet individual requirements. (For general directions, 
refer to Chapter II.) 
ORDER OF EXERCISES FOR PROGRAM. 
1. Introductory: Breathing, relaxation, posture training. 
2. General flexibility. 
3. Local flexibility. 
4. Self-correction (at mirror). 
5. Strong back exercise. 
6. Abdominal exercise. 
7. Relaxation (hook lying position). 
8. General strengthening exercises in the corrected posi- 
tion. 
9. Posture training. 
10. Walking in good posture and balance exercises of 
varying sorts. 
11. Relaxation. 
Generally. —It is important to pay attention to the position 
from which the exercise is being done, as well as to the 
movement itself, since an exercise, otherwise excellent, may 
fail in its result if performed from a poor starting position, 
7 98 
FAULTY ANTERO-POSTERIOR POSTURE 
The teacher should have a thorough understanding of 
kinesiology in order that the exercises may accomplish 
the correct aims, and emphasis be placed upon the use of 
the proper muscles. The relation of motor to antagonistic 
muscles must be appreciated* and care taken that the 
return to position after a good exercise does not necessitate 
strong contraction of opposing groups of muscles which 
already may be overstrong. An illustration in point would 
be the exercise shown on page 111 (Figs. 41 and 42). The 
object is to strengthen the rhomboid muscles, necessitating 
a strong pull downward. A fault often observed is of 
emphasis on the upward push and the arms falling by 
gravity, and thus the aim of the exercise is nullified. 
The purpose of corrective exercises should be twofold: 
habit-freeing and habit-forming. If the purpose is to over- 
come habits of poor posture, in order that habits of good 
posture may be established, the logical procedure is to 
discard old habits and to free the body from them. Then 
the habit-forming exercises can be given with benefit. 
Daily occupations and activities encourage the forward 
position of the arms and the upward rotation and abduc- 
tion of the scapulae. Weak rhomboid muscles are almost 
universal. Also, overemphasis of the sitting position 
results in the weakening of the anterior trunjk muscles, so 
in the effort to correct, it seems reasonable to direct atten- 
tion to exercises which counteract these influences. Stress 
should be laid upon the trunk, abdominal and lower back 
exercises, and upon those producing adduction and down- 
ward rotation of the scapulae, and less attention may be 
given to arm-raisings and extensions. 
Fewer exercises are being given in the standing position 
and more value is found in those lying on the mat and in 
the sitting position. The body is freed and muscles streng- ORDER OF EXERCISES FOR PROGRAM 
99 
thened without the problem of the mechanics of the upright 
position. These exercises should, however, be followed by 
intensive posture training and a few exercises in the stand- 
ing position. 
Appreciating the fact that the body is a segmented 
mechanism, with the base of support the feet, its proper 
adjustment must begin at this point. The individual 
should be shown how to carry the weight forward sufficiently 
to bring it over the arches. The knees must be neither 
hyperextended nor flexed, as their position influences the 
inclination of the pelvis, and this in turn controls the posi- 
tion of the spine. Considerable training should be given in 
pelvic control in learning the proper muscular coordinations. 
Summary. 
1. Habit-freeing exercises. 
2. Ilabit-forming exercises. 
(a) Exercises for pelvic control. 
(b) Exercises for strengthening abdominal and trunk 
muscles. 
(c) Exercises for upper back. 
(d) Posture training. 
Introductory Exercises.—These are of value in familiarizing 
the pupil with the work, in getting him into the spirit of it, 
and in imparting the feeling that he has discarded faulty 
adjustments and is building a new structure. 
Begin each lesson with one or two vigorous all-around 
exercises which will stimulate the circulation and induce deep 
breathing. For example, a quick run around the room, 
spring-jump sideways with arm flinging sideways-upward 
(known as the “jumping-jack”), running in place and other 
energizing movements (Fig. 24). 
Breathing.—Many people breathe improperly and insuffi- 
ciently. When asked to take a deep breath they throw back 100 
FAULTY ANTFRO-FOSTER!OR POSTURE 
the shoulders, hollow the back, strain the neck and stiffen the 
chest by contraction of the muscles. The result is that the 
lungs are unable to expand except in a limited area and 
the breathing is very shallow. Definite instruction should 
Fig. 23.—Fundamental position. 
Fig. 24.—Jumping-jack exercise. 
be given in regard to the proper manner of breathing. It is 
well to explain the necessity for keeping the chest flexible 
and free from tension, so that expansion may take place 
without forced muscular action. Slow, deep breathing is ORDER OF EXERCISES FOR PROGRAM 
101 
then practised. One helpful device is to have the pupil place 
the hands lightly on the sides of the lower ribs and breathe 
deeply, so that the hands will be pushed out sideways indicat- 
ing proper action of the diaphragm. This should be done 
without lifting the shoulders. 
Exercises should be of such a character, and be done vigor- 
ously enough to stimulate deep breathing. This is a more 
desirable way of acquiring habits of right breathing than 
that of giving special breathing exercises. Care should be 
taken that a pupil is always breathing freely during the 
exercises and not “holding the breath.” If he is unable to 
breathe easily and naturally, the exercise is probably too 
difficult and should be modified. 
There should be free circulation of air in the gymnasium. 
Relaxing Exercises.—These are given next on the program, 
in order to free the body as far as possible from habits of 
excessive muscular tension. The inhibition of muscular 
action thereby necessitated destroys the neuromuscular 
coordinations which have been formed by the faulty habits 
of posture. The muscles thus freed are ready to respond to 
new stimuli and other coordinations resulting in good pos- 
ture may be established more quickly. 
In the experience of the writer, the following relaxing 
exercises have been proved to be of definite value: 
1. Standing Position: Trunk-freeing exercise. Relax the 
muscles of the neck, allowing head to fall forward. Relax 
the spine slowly until trunk swings forward from the hips. 
With knees extended swing trunk freely in all directions, 
allowing the arms to hang loosely. Then rise slowly to 
upright position extending lower back, upper back and finally 
neck and head, the teacher showing the pupil how to assume 
a posture of ease and balance, with no strain, at the end of 
the movement. Relaxing exercises as given in the funda- 102 
FAULTY ANTERO-POSTERIOR POSTURE 
mentals of dancing: “The crawl”; “the roll”; “folding and 
unfolding”; are especially valuable in this connection.1 
2. Stand Erect: “Arm-pendulum” exercise. Swing the 
arms from the shoulders like pendulums. Allow them to 
swing gradually more slowly, until they come to rest natu- 
rally at the sides of the body. 
Fig. 25 
Fig. 26 
Fig. 27 
Fig. 28 
Fig. 25.—Poor posture. 
Fig. 26.—Exaggerated and stiff 
posture. 
Fig. 27.—Posture of ease. 
Fig. 28.—Ease and poise in walking. 
3. Stand Erect: “Leg-pendulum” exercise. Grasp a sup- 
port with one hand. Swing each leg freely in all directions. 
The bodily freedom attained by these and similar exercises 
is most desirable. 
1 H’Doubler, M. N.: A Manual of Dancing. ORDER OF EXERCISES FOR PROGRAM 
103 
Music.—An asset to the equipment of the gymnasium is 
a Vietrola, which may be used during certain parts of the 
lesson. It is especially good for accompanying these relax- 
ing exercises. The psychological effect of the music is bene- 
ficial and is frequently a means of stimulating effort. 
Posture should now be presented concretely and its full 
meaning explained. This essential may be taught by the 
excellent practice of first placing the pupil in the proper 
position, doing this several times if necessary, until, by 
“getting the feeling’’ gradually, he will be able to assume the 
posture through his own unaided effort. The body should 
be held as tall as possible without strain. There should not 
be any hollowing of the back, hyperextension of the knees, 
or tension in the neck. The weight of the body should be 
carried slightly forward over the arches of the feet, head 
up, and easily poised. Emphasize ease of posture (Figs. 25 
to 28). As previously indicated, attention to the position 
of the pelvis is important. A helpful means of teaching 
the muscular coordination necessary to control the position 
of the pelvis, is to place one hand over the sacrum, pressing 
downward, and the other hand lightly on the abdominal 
muscles, suggesting a lifting of the abdomen and waist. 
Exercises. 
1. Passive chest-lifting (for increasing antero-posterior flexi- 
bility). 
Position.—Pupil sitting on stool; feet on floor; hands 
at neck. 
Movement.—Teacher grasps elbows and draws them 
slowly backward. Pushes forward with knee on 
dorsal convexity simultaneously. Relax. Repeat 
10 to 20 times (Fig. 29). 104 
FAULTY ANTERO-POSTERIOR POSTURE 
2. Stretching chest muscles. Passive (for increasing flexi- 
bility) (Fig. 30). 
Position.—Pupil lying on back. Pad under scapulae. 
Movement.—Teacher presses downward slowly on 
elbows until muscles are well stretched. Relax. 
Repeat 20 to 30 times. 
Fig. 29.—Passive chest-lifting. 
3. Stretching chest muscles. Active (for increasing flexi- 
bility) (Fig. 31). 
Position.—Lying on back; knees bent; hands at 
shoulders, holding dumb-bells (1 to 2 pounds). 
Movement.—Extend arms sideways, allowing weight 
of dumb-bells to exert a passive stretch on chest, 
at end of extension. Return to first position by ORDER OF EXERCISES FOR PROGRAM 
105 
flexing the elbowTs, keeping the back flat, and chest 
expanded. Ten times. 
4. Hanging from horizontal bar. (a) Active (for strength- 
ening the back muscles). 
Fig. 30.—For stretching chest muscles. 
Fig. 31.—Arm extension sideways with dumb-bells. 
Position.—Overgrasp, on horizontal bar; hands apart 
the width of shoulders. 
Movement.—Suspend trunk from hands, with active 
tension of all the back muscles, without bending 
elbows, or pulling trunk upward (Fig. 32). 106 
FAULTY ANTERO-POSTERIOR POSTURE 
5. Hanging from horizontal bar. (6) Passive (for stretch- 
ing muscles and extending spine) (Fig. 33). 
Position.—Same as in Exercise 4. 
Fig. 32.—Active hanging position Fig. 33.—Passive hanging for 
for strengthening the back muscles. stretching; note difference between 
active and passive hanging. 
Movement.—Suspend trunk from hands, entirely 
relaxed, allowing the weight of the body to make 
traction on the spine. ORDER OF EXERCISES FOR PROGRAM 
107 
6. Hand suspension, with forward push (for increasing 
flexibility). 
Position.—Overgrasp on horizontal bar. Hands apart, 
the width of shoulders. 
Movement.—Teacher places hands on scapulae of pupil 
and exerts strong push forward. Position should 
be held a few moments. Return to first position. 
Repeat 5 times (Figs. 34 and 35). 
7. Prone-lying. Trunk raising (for dorsal flexibility) (Fig. 
36). 
Position.—hie on face. Feet supported. Arms at 
sides of body. 
Movement.—Raise head and shoulders backward. 
Rotate arms, turning palms outward. Hold posi- 
tion a few seconds. Return to first position. Relax. 
Repeat 8 to 15 times. 
Note.—This movement should be localized in the 
cervical and dorsal regions and is inadvisable where 
there is a tendency to lordosis. It may be varied 
by changing position of arms, viz., hands on hips; 
hands at neck; arms extended sideways. 
8. Exercise for round hollow back (Figs. 37 and 38). 
Position.—Sit erect, astride plinth or stool. Hold 
wand in hands on knees. 
Movement.—1. Swing legs forward until extended on 
plinth in “long sitting” position. 
2. Simultaneously swing wand forward upward, arms 
extended overhead, and bend elbows, bringing 
wand behind shoulders. 
Note.—Do not thrust the head forward or around 
the back. 
9. Resistive arm flexion (for chest expansion and muscle- 
strengthening) (Fig. 39). 108 
FAULTY ANTERO-POSTERIOR POSTURE 
Figs. 34 and 35.—Hand suspension with forward push. Fig. 34, starting 
position; Fig. 35, the forward push. 
Fig. 34 
Fig. 35 
Fig. 3G.—Prone-lying; trunk raising. Fig. 37.—Continuous line. Starting position. Dotted line, intermediate 
position. 
Fiq. 38.—Final position. 110 
FAULTY ANTERO-POSTERIOR POSTURE 
Position.—Lying on back. Arms extended upward. 
Movement.—Teacher grasps hands. Pupil pulls arms 
down, bending elbows, against resistance. Extend 
arms, without resistance. Teacher gives a strong 
pull on arms at end of extension. Repeat 10 to 
20 times. 
Fig. 39.—Resistive arm-flexion. 
10. Arm and leg flinging exercise (general exercise) (Fig. 40). 
Position.—Lying on back, on mat. Arms at sides of 
body. Legs extended. 
Movement.—Fling both arms forward, upward, over 
head, until extended on mat. At the same time, 
fling one leg forward from the hip, until at right 
angles to the body. Return to first position. Same 
movement with both arms and the other leg. 
Repeat rhythmically 20 to 30 times or more. 
11. Bar exercise (for strengthening the back muscles) 
(Figs. 41 and 42). ORDER OF EXERCISES FOR PROGRAM 
111 
Fig. 40. Continuous line position. Dotted line, the movement. 
Fig. 41.—Position at start and finish 
of exercise. 
Fig. 42.—Intermediate position. 112 
FAULTY ANTERO-FOSTERIOR POSTURE 
Position.—Sitting; feet on floor. Grasp iron bar (2 
pounds or more), which is held behind the shoulders, 
at level of upper borders of scapulae. 
Movement.—1. Push bar slowly upward until arms are 
fully extended. 
2. Pull bar downward slowly and forcefully, con- 
tracting the muscles of the back strongly. (For 
strengthening rhomboids.) 
Exercises for Strengthening Muscles in the 
Corrected Position. 
12. Assume the best posture possible, and hold, during the 
exercise. 
Position.—Standing, arms at sides of body. Hold 
dumb-bells (2 pounds). 
Movement.—Raise arms slowly sideways to horizontal. 
Return slowly to first position. Repeat as long 
as it is possible to hold the correct posture (Fig. 43). 
13. “Correction” at the mirror. (For training new coordi- 
nations.) 
(a) Position.—Stand in front of mirror. Assume 
the correct position. Relax. Assume position and 
relax frequently. 
(b) Assume correct position. Walk around the room 
and endeavor to hold good position. Return to 
mirror and observe. 
14. Slow arm extension (Fig. 44). 
Position.—Stand in correct position. Elbows bent. 
Hands at shoulders. 
Movement.—Extend arms slowly sideways, extending 
fingers and reaching as far as possible without lift- ORDER OF EXERCISES FOR PROGRAM 
113 
ing the shoulders or tensing the neck, retracting the 
scapulie by strong contraction of rhomboids. 
15. Trunk bending forward (Fig. 45). 
Position.—Stand in correct position. Hands on hips 
or at neck. 
Fig. 43.—Arm raising sideways with dumb-bells. 
Movement.—Bend forward from the hips, keeping 
the back flat. Return to erect position 10 times. 
• (Strong back exercise.) 
16. “Aeroplane exercise” (for general flexibility and for 
strengthening muscles of trunk and waist) (Fig. 46). 
Position.—Stand erect with feet apart. Arms 
extended sideways. 
Movement.—Twist trunk backward to left, trying to 
touch left toe with right hand by bending forward. 
8 114 
FAULTY ANTERO-POSTERIOR POSTURE 
Keep knees extended and do not change the position 
of the arms. Return to erect position, twist trunk 
forward. Pause. Repeat, to opposite side, 5 times 
to each side. 
17. “Bicycle exercise.” (By permission of Mr. W. Curtis 
Adams, Pompton, N. J.) (Figs. 47 and 48.) 
Fit;. 44.—Slow-arm extension 
Position.—Lying on back, with buttocks against wall. 
Hips flexed; knees extended; hands at shoulders. 
Movement.—1. Drop one leg, flexing knee and hip, 
and extending ankle. Fling both arms upward, 
extending fingers. 
2. Extend leg, sliding it up on the wall, pushing with 
heel until ankle is well flexed. Allow the other Fig. 45.—Trunk bending forward. 
Fig. 46.—Aeroplane exercise, 116 
FAULTY ANTERO-POSTERIOR POSTURE 
leg to drop (as in 1). Bend elbows, bringing hands 
to shoulders. Repeat rhythmically. Number of 
times may be increased almost indefinitely, with 
short periods of rest interspersed. Object of 
exercise is general strengthening of back, chest 
and waist muscles. It corrects tendency to lordosis. 
Also stretches posterior musculature and tendo 
Achillis and gives excellent foot action. 
18. Sitting; trunk twisting (strengthening abdominal and 
lower back muscles) (Figs. 49 and 50). 
Position.—Sitting erect astride a stool or plinth. 
Hands on hips or neck; feet on floor. 
Movement.—1. Twist trunk to side, keeping elbows in 
plane with the body. 
2. Twist to opposite side. Repeat 8 to 10 times, each 
side. 
19. Sitting; trunk bending sideways (strengthening waist 
and lower back) (Figs. 51 and 52). 
Position.—Sitting as in Exercise 18. 
Movement.—Bend trunk to side; raise to erect position. 
Bend to opposite side. Repeat 8 to 10 times each 
side. 
20. “Stretching exercise” (for strengthening trunk muscles). 
Position.—Lie on the back. Arms bent; hands behind 
neck. 
Movement.—Extend one arm upward, and at the 
same time stretch across the body with leg on 
same side (Fig. 53). 
21. For correcting lordosis. 
Long sitting position. Pupil sits on floor, with legs 
extended forward, keeping the back erect. This 
position may be taken also, by having the back 
placed against the wall (easier in the beginning). ORDER OF EXERCISES FOR PROGRAM 
117 
Fig. 47.—The Adams bicycle exercise; first movement. 
Fig. 48.—The Adams bicycle exercise; second movement. Fig. 49.—Position. 
Fig. 50.—Movement. 
Fig. 51.—Position. 
Fig. 52.—Movement. ORDER OF EXERCISES FOR PROGRAM 
119 
If a pupil has a marked lordosis, or is unable to perform 
an exercise without hollowing the back, this tendency may 
Fig. 53.—An exercise for strengthening trunk muscles (Exercise 20). 
Fig. 54.—Lordosis not sufficiently corrected by the sitting position. 
be lessened by having the exercise performed in the sitting 
position and the tendency entirely eliminated by assuming 
the “long sitting position” (Figs. 54 and 55). 120 
FAULTY ANTERO-POSTERIOR POSTURE 
22. “Half somersault.” For correcting lordosis. 
Position.—Lie on the back. Arms at sides; knees 
bent; feet on floor. 
Fig. 55.—Lordosis in Fig. 54 eliminated by long sitting position. 
Fig. 56.—An exercise for the correction of lordosis. 
Movement.—Draw knees upward to chest. Extend 
knees, swinging legs over head and raising pelvis ORDER OF EXERCISES FOR PROGRAM 
121 
from floor (Fig. 56). Return to position by flexing 
the knees. 
Fig. 57.—Reversed ladder-climbing for correction of lordosis. 
I ig. 58.—May be adapted to strength as follows: 1-2-1; 1-2 3-2-1: 
1-2-3-1; 1-3-1. 122 
FAULTY ANTERO-POSTERIOR POSTURE 
23. Reversed ladder-climbing (for lordosis). 
Position.—Lie on back. Grasp stall bars. 
Movement.—Throw legs over head. Grasping stall 
bar with toes. Climb upward as far as possible 
and downward, returning to first position again 
(Fig. 57). 
Fig. 59.—Head bending Fig. 60.—Arm flinging sideways, 
backward. 
24. Lying; knee bending (abdominal exercise). 
Position.—Lying on back; arms at sides of body; 
legs extended. 
Movement. —1. Flex knees and hips. 
2. Extend knees. 
3. Lower extended legs slowly to floor. Repeat 
only 4 or 5 times in the beginning. 
k ORDER OF EXERCISES FOR PROGRAM 
123 
Note.—This exercise may be made easier by simply 
drawing the knees to chest and replacing to floor, 
without extension upward. It may be made more 
vigorous by raising both legs, extended, to per- 
pendicular and returning in same way to first posi- 
tion (Fig. 58). 
25. Standing. Head bending backward (for improving posi- 
tion of head and strengthening muscles in cervical 
region) (Fig. 59). 
Fig. 61.—A good general exercise. Position of knees prevents lordosis. 
Position.—Stand erect. Hands on hips. 
Movement.—Draw head horizontally backward with- 
out lifting the shoulders. 
26. Standing; arm flinging sideways (for improvement of 
posture in upper dorsal and cervical regions) (Fig. 
60). 
Position.—Stand erect. Arms bent at shoulder level 
and elbows drawn well backward. 124 
FAULTY ANTERO-POSTERIOR POSTURE 
Movement.—Fling arms forcibly sideways, drawing 
head back at the same time. 
27. Spine-stretching. 
Position.—Sitting, hands placed lightly on top of 
head. 
Exercise. Stretch up with head, extending spine 
without lifting the shoulder girdle. 
28. Hand stand at stall bars. i\.n exercise of this type is 
valuable in many programs. The position is that 
of inverted hanging, head down, body extended 
upward, with back against the stall bars. This 
position reverses and stimulates the circulation, 
also corrects a tendency to ptosis by allowing the 
organs to be thrown upward into the body cavities. 
29. Heel-raising. Knee-bending, with knees together. A 
good general exercise (Fig. 61). 
Exercises for Poise and Balance. 
1. Slow toe march. Walk on toes. Feet straight. 
2. Walk in good posture, carrying weight on head. 
3. Poising exercise. Stand on one foot, heel raised, bend 
other knee upward at right angles. Raise one arm upward 
extending other arm downward. To lie done with extreme 
freedom. 
4. Progressive walking exercise. 
(a) 1. Step forward on one foot. 
2. Lift backward heel, transferring weight to 
forward foot. 
3. Replace backward heel. Repeat several times. 
Same with other foot forward. 
(b) Repeat 1 and 2 as in Exercise 4. Then swing 
backward leg forward and take a step, pro- TYPICAL PROGRAMS OF EXERCISES 
125 
gressing into a slow walk, which may be acceler- 
ated gradually (Fig. 28). 
Sitting Posture. 
More emphasis should be laid upon the importance of the 
correct sitting posture and definite instruction be given in 
regard to this. It would be wise to embody the sitting 
position in the form of an exercise in every program. This 
exercise could be done to advantage with a group as follows: 
March class to stall bars. Stall bar benches down. 
About face. 
Sit. 
1. Draw one foot to rear. 
2. Transfer weight to backward leg. 
3. Bend knees. 
4. Lower body slowly to sitting position. 
Stand. 
1. One foot to rear. 
2. Bend forward from hips. 
3. Push with backward leg. 
4. Lift body to erect position, transferring weight to for- 
ward leg. 
TYPICAL PROGRAMS OF EXERCISES. 
I. Stiff Round Back. 
Type.—Flat chest; contracted pectorals; flexed knees; 
pelvic angle decreased; weight over heels; abdomen 
relaxed. 126 
FAULTY ANTERO-POSTERIOR POSTURE 
Indications for Exercise.—Stretch chest muscles; strengthen 
rhomboids; strengthen abdominal muscles; posture 
training. 
Exercises. 
1. Relaxation exercises. 
2. General flexibility—Aeroplane (No. 16). 
3. Posture training. 
4. Swing on rings. 
5. Passive chest-lifting (No. 1). 
6. Bicycle (No. 17). 
7. Mat. Flexions (No. 10). 
8. Pelvic control exercises. 
9. Walking and sitting exercises in correct posture. 
10. Posture training at mirror. 
11. Ilook-lying ninth-rib breathing. Hands placed lightly 
on lower ribs. 
12. Rest relaxed on mat. 
II. Flexible Round Back. 
Type.—Floppy; scapulae prominent; knees hyperextended; 
relaxed rhomboids; pelvic inclination decreased. 
Indications for Treatment.—Coordination; strengthening 
muscles; pelvic control; much stress on posture; 
exercises for flexibility not necessary. 
Exercises. 
1. “Jumping-jack” (Fig. 24). 
2. Relaxation exercises. 
3. Posture training. 
4. Active hanging. 
5. Pelvic control exercises. TYPICAL PROGRAMS OF EXERCISES 
127 
6. Sitting (stretch). Pull iron bar slowly downward 
(Fig. 41). 
7. “Bicycle.” 
8. Self-correction at mirror. 
9. Practice walking and sitting. 
10. Aeroplane exercise. 
11. Hook lying. Deep breathing. 
12. Best, relaxed, on mat. 
III. Stiff Hound Hollow Back. 
Type.—Shoulders round; head forward; abdomen promi- 
nent; lower back weak and hollow. 
Indications.—Increase flexibility of upper back; strengthen 
lower back and abdomen; care taken not to increase 
lordosis. 
Exercises. 
1. Jumping-jack (Fig. 24). 
2. Relaxation exercises. 
3. Posture training. 
4. Low hanging at stall bars. Legs extended forward. 
5. Lying on back. Knee-bending. (Abdominal, Fig. 58.) 
b. Stride sitting. Trunk-twisting and trunk-bending. 
(Exercise 18 and 19.) 
7. Bend hook lying. Arm extension with dumb-bells 
(Fig. 31). 
8. Long sitting (at wall). Pull arms slowly downward 
(rhomboids). 
9. Standing at wall. Pelvic control exercises. 
10. “Bicycle.” 
11. Practice correct posture. Walking and sitting. 
12. Relaxation and rest. 128 
FAULTY ANTERO-POSTERIOR POSTURE 
IV. Lordosis. 
Type.—Position of upper back fairly good; extreme 
hollow in lower back; pelvic angle increased; knees 
hyperextended. 
Indications.—Strengthen lower back; attention to position 
of knees; concentrate on position of pelvis. 
Exercises. 
1. Forward bending of trunk; relaxed. 
2. Standing. Heel-raising and knee-bending; knees 
straight (Fig. 61). 
3. Plinth. Stride sitting; trunk bending forward; back 
flat. 
4. Mat. Knee-bending upward (half somersault) (Fig. 
56) or reverse ladder-climbing. 
5. Bicycle. 
6. Sitting. Swing bar over head (Fig. 38). 
7. Pelvic control. Wall. 
8. Posture training. 
9. Walking in good posture. 
10. “The Mosher” exercise. 
11. Rest; relaxed on mat. CHAPTER VIII. 
CORRECTIVE EXERCISES FOR GROUPS. 
In a book devoted to the subject of individual gymnastics, 
where stress is laid upon the necessity for individual attention 
in the application of exercises, it would seem almost con- 
tradictory to find a chapter given to the subject of corrective 
exercises for large groups. 
The need for some work of this nature is being felt increas- 
ingly by teachers of physical education in schools, especially 
the public high schools, where large groups of students must 
be handled. 
It is apparent that the present program of physical edu- 
cation in the schools must be reconstructed, or else sup- 
plemented by special exercises for the correction of faulty 
postures, so that correct posture may become the rule 
rather than the exception. 
In schools where classes are large, ranging perhaps from 
fifty to one hundred, where time is limited and the program 
of the teacher is already overfull, individual lessons are 
not possible except in rare instances. What, then, may be 
accomplished with a large group? Is it possible to plan 
work of such character as may meet at least some of the 
individual needs? To this end plans are being tried out, 
in most instances with considerable success. “Mass cor- 
rectives;” “group correctives;” “posture group work” are 
some of the terms applied. 
How can classes of this character be organized in order 
that the greatest benefit may accrue to the individual, 
and what type of exercises shall be chosen? It seems 130 
CORRECTIVE EXERCISES FOR CROUPS 
possible that programs can be planned such as will be of 
much value, and that interest can be stimulated in the 
student which may establish a desirable posture conscious- 
ness. 
Several plans for the organization of such classes are 
subjoined with exercises indicated. 
In General.—A physical examination of each student 
is presupposed. Pupils having scoliosis are advised to 
have treatment by a specialist. The teacher, if time per- 
mits, may organize small groups for individual work for 
the correction of scoliosis and other specific conditions at 
other than class periods. These pupils should also join the 
“group posture class.” 
Group posture work may be made either a part of each 
program in the gymnasium, or certain entire periods may 
be devoted to it, the exercises distributed through the 
program of which they constitute the major part. 
Plan I. 
1. Class organized into squads according to type of pos- 
ture and exercises necessary. 
2. Each squad led by a captain chosen by instructor. 
(This could be made a merit for good posture, and thus act 
as an incentive. The captains could be changed monthly, 
and some insignia given the retiring captain to be held as 
long as her good posture continued.) 
3. Captains attend regular meetings, where exercises are 
taught by instructor. 
4. Posture grades can be given individuals and also to 
squads. By posting these, lively interest through com- 
petition can be aroused. Short reports and talks could be 
given at assembly monthly. CORRECTIVE EXERCISES FOR GROUPS 
131 
5. In the gymnasium. 
(a) Mass work. 
(b) Squad work. 
Division of program. 
Marching, 5 minutes. 
Squad exercises, 15 minutes. 
Mass work with instructor, 10 minutes. 
Dancing or games, 10 minutes. 
Period, 40 minutes. 
Plan II. 
Squads and squad leaders as before, but in this ease the 
squad leaders are assigned to the supervision of apparatus 
or certain exercises. The students pass from one exercise 
to another in routine. 
Example, supervision of: 
(a) Hanging from horizontal bar. 
(b) Bicycle exercise. 
(c) Scissors exercise. 
(d) Passive chest lifting. 
(e) Foot exercises. 
Division of program as in Plan I. 
Squads can be organized for special exercises not alone 
for the correction of posture but for other purposes as well, 
viz.: 
Squad 1. Posture correction. 
Squad 2. Overweight. (A diet list should be given these 
students and chart posted recording weight.) 
Squad 3. Constipation. 
Plan III. 
One period once a week or during each regular period; 
students assist one another in many of the exercises. 132 
CORRECTIVE EXERCISES FOR GROUPS 
The following are some of the exercises which may be 
done in couples, and worked in as part of the regular pro- 
gram. 
Students arranged in files so that each is standing beside 
a partner. 
1. Trunk freeing exercise (p. 101, Exercise 1) alone. 
2. Arm pendulum exercise (p. 102, Exercise 2) alone. 
3. Leg pendulum exercise (p. 102, Exercise 3). 
(а) Arms extended sideways; hands on partner’s 
shoulder. 
(б) Swing outer legs. 
(c) About face and repeat. 
4. Posture correction in files. 
(а) March; halt in files. 
(б) Alternate files face so that partner is observed 
in profile. 
(c) Correct the posture of partner. 
(d) About face. 
(e) Correct posture. 
5. Passive chest-lifting. 
(a) Number 1 sits on floor, either “long sitting ’ 
or tailor fashion. 
(b) Number 2 takes good fallout position behind. 
(c) Passive chest-lifting (Fig. 29). 
■(d) Change partners. 
6. (a) Sitting tailor fashion on floor; back to back; arms 
extended upward grasping partner’s hands. 
(b) Flex elbows, drawing arms slowly to sides, 
with resistance (for strengthening rhom- 
boids). 
7. (a) Position sitting as in Exercise 6; partners facing 
one another. 
(6) Arms extended forward, grasping partner’s 
hands. TYPICAL PROGRAMS OF EXERCISES FOR GROUPS 
133 
(c) Number 1 bends elbows; drawing arms hori- 
zontally backward; inclining trunk slightly 
backward at same time. Number 2 offers 
slight resistance. 
(d) Alternate. 
Exercises of this character may be distributed through 
the teachers “mass-corrective” program and tend to make 
interest more keen. 
TYPICAL PROGRAMS OF EXERCISES FOR GROUPS. 
I. 
1. Habit-freeing exercises. 
Arm pendulum. 
Leg pendulum. 
Spine “folding and unfolding.” 
2. Training for “Poise.” 
(а) Balance body with legs, trunk and head in 
alignment. 
(б) Raise slowly on toes. Down softly on heels. 
Repeat more quickly, keeping poise. 
Note.—1 and 2 may be performed with music. 
3. “Grip walk” exercise. (See p. 221, Exercise 7.) 
4. Posture training in couples. 
5. Prone bend standing position; slow arm extension 
sideways. 
6. Marching to stall bars; “correct sitting” exercise. 
7. Long sitting on floor; arm-flexion and extension with 
partners. 
8. Standing. “Aeroplane” exercise. 
9. Standing. Heel-raising; knee-bending, with knees 
together. 
10. Slow walking for inspection. 134 
CORRECTIVE EXERCISES FOR GROUPS 
Note.—Exercise 10. At the end of each period the class 
marches slowly, single file, around the gymnasium. Teacher 
observes students in profile; quickly notes and comments 
on posture of each, thus: “head up”; “good posture”; “too 
stiff”; “hollow back,” etc. 
II. 
1 and 2 as in previous program. 
3. Run in place. 
4. Posture correction in couples. 
5. Sitting. Passive chest-lifting (in couples). 
6. Slow walking and sitting exercises. 
7. Standing. Foot-gripping exercise. 
8. Active hanging on stall bars or boom. 
9. Sitting on floor. Hands on head. Spine-stretching. 
10. Sitting. Hands on lower ribs; “ninth-rib breathing.” 
11. Walking for inspection. 
Summary.—The majority of the exercises given in the 
preceding chapters may be used, with slight adaptations, in 
group work. Recreational values must not be overlooked if 
the best results are to be obtained. 
In the opinion of the author, the content of a lesson not 
alone for “group correctives” but of any gymnastic lesson 
might be formulated thus: 
1. Body-freeing exercises. 
2. Specific posture exercises and posture training. 
3. Games and dances. CHAPTER IX. 
VISCEROPTOSIS. 
“Ptosis” is the term used to indicate a drooping or 
falling of any part of the body. The most frequent appli- 
cation of the term is to the abdomen and to the viscera. 
Thus “abdominal ptosis” and “visceroptosis” imply the 
relaxation of the muscles constituting the abdominal walls 
and the displacement downward and forward of the viscera. 
The “dropped stomach” of which one hears in common 
parlance is one form of visceroptosis. This condition is 
one of the most pernicious of the accompaniments of poor 
posture, and the cause of so many physical and mental ills 
that it well merits the attention which is directed to it. 
There is a type of congenital ptosis, but in the majority of 
cases it is acquired. 
As has been shown in the chapter on Posture, all the seg- 
ments of the body should be in such relation to one another 
and to the center of gravity that they form a completely 
adjusted mechanism for the performance of efficient work, 
and in this state the organs thus coordinated are in the 
most advantageous position for healthful functioning. The 
importance of the strength of the abdominal muscles, in 
preserving this relationship and in the support of these 
organs, cannot be overestimated, yet these are the groups 
most frequently weak, especially in women. 
ETIOLOGY. 
The stress of the upright position, the constant downward 
pull of gravity, the prevalence of sedentary occupations, all 136 
VISCEROPTOSIS 
tend to ptosis. The distention of the abdomen, the after- 
effect of relaxed muscles, and all that child-bearing entails, 
is also another potent factor with many women. In many 
instances individual psychology may be basic. Mental and 
physical relaxation are closely allied. The person with an 
inferiority complex depresses head and chest and assumes a 
position showing little or no muscular control. The resultant 
condition is a sagging along the lines of least resistance, a 
true ptosis of the whole mechanism. 
The abdominal viscera, stomach, liver, pancreas, spleen, 
kidneys and intestines are held in position by ligamentous 
folds of peritoneum, binding them to the posterior walls of 
the abdomen. Their contiguous surfaces are so molded that 
they fit around one another to a nicety, without undue 
pressure. The forward slant of the dorso-lumbar spine, and 
the posterior abdominal muscles afford points of support 
as well. 
In the well-poised body, the pelvic cavity is posterior to 
the abdominal, and the weight of the abdominal organs is 
borne by the abdominal muscles and does not fall upon the 
pelvic organs. 
Between the abdominal and thoracic cavities, is spread 
the diaphragm. When this great muscle and those of the 
anterior and posterior walls, and the floor of the cavity are 
kept in good tone, a strong pressure is exerted upon the 
organs, which is known as the intra-abdominal pressure, and 
helps still further to hold them in place. 
In the condition of visceroptosis, the abdominal muscles 
relax, thus removing the anterior support, the intra-abdomi- 
nal pressure is lessened, organs collapse, press downward 
upon one another, the weight is transmitted to the pelvic 
cavity and organs, ligaments become strained, the diaphragm 
does not work as freely, the chest becomes depressed and the TREATMENT 
137 
heart and lungs are no longer in the best position for func- 
tioning. In addition, there may be undue pressure upon 
nerves and bloodvessels. There is frequently pain in the 
back and a feeling of chronic fatigue. It is only reasonable 
to conclude that there is almost no limit to the disturbances 
of function of the organs, and of the nerves, which may 
be traced to this source. 
A knowledge of bodily mechanics is most important for 
the teacher of physical education as well as for the medical 
practitioner, so that when advice is sought for some local 
trouble, the body, as a whole, may be considered as pos- 
sibly participating, and the maladjustments and results 
incident upon poor posture be taken into account. For 
example, in a condition of chronic indigestion, exercises for 
the correction of a ptosis—the mechanical readjustment 
of the body—which would result in improving the position 
and functioning of the stomach, would be of far more last- 
ing value than the application of drugs which, at the best, 
are only palliative, and while temporarily alleviating uncom- 
fortable symptoms, do not strike at or reach the root of the 
difficulty. 
TREATMENT. 
Consideration should be first given to contributory causes, 
such as a faulty arrangement of clothing, tight waistbands 
and heavy skirts, which tend to drag down on the abdomen, 
or a corset poorly adjusted, which makes a downward 
pressure on the organs. 
The high-heeled shoe is distinctly evil in its influence, and 
low-heeled shoes should be advised in all cases. (This 
subject is discussed at length in the chapter on Shoes.) 
A certain type of corset is frequently advised as an adjunct 
to the treatment by exercise for some of the cases of viscero- 138 
VISCEROPTOSIS 
ptosis. It should he low and not constrict the waist, but 
long below the waist, with a firm grip around the hips, and 
be adjusted in such a way that the abdomen is lifted, thus 
preventing the downward sag of the organs. This should 
be preferably a front-laced corset adjusted in the lying 
position. 
One authority believes that in most of the severe cases 
there is a marked “run-down” condition—both physical and 
mental—attended by loss of weight, and that rest of half an 
hour or an hour after each meal, lying in a horizontal position 
on the back, should accompany the treatment. In this 
position the organs return to their normal adjustment and 
the strain on muscles and ligaments is relieved.1 Mental 
stimulation along the line of encouraging self-confidence, and 
promoting interest in life would be necessary in many cases. 
Attention cannot be called too often to the fact that 
general hygiene is always of prime importance. 
Exercises.—Exercises should be of a similar type as those 
for improvement of posture, and for strengthening especially, 
the muscles of the lower back, abdomen and waist. (See 
Chapter VII.) 
The bladder should be emptied before beginning any 
abdominal exercises. 
1. Knee-chest Position.—Kneel on mat. Bend trunk 
forward from the hips, until chest and elbows rest on the 
mat, with arms forward bent, head resting on hands. This 
position should be taken once or twice a day, five minutes 
or more at a time. It allows the organs to fall back into 
normal position, relieves strain and improves abdominal cir- 
culation (Fig. 62). This position should be assumed in bed 
for five minutes after retiring, and the patient instructed 
1 Chase, R. F.: The Treatment of Visceroptosis, Boston Med. and Surg. 
Jour., August 30, 1917. TREA TMENT 
139 
to lie down immediately afterward, without assuming the 
upright position again, thus encouraging the organs to remain 
in their corrected position overnight. 
(a) Leg-raising backward from knee-chest position. 
Position.—As in previous exercise. 
Movement.—Raise one leg backward, taking one or two 
deep breaths at the same time. Replace leg; rest a 
moment and repeat with the other leg. 
Note.—The action of the diaphragm in breathing 
facilitates the correct adjustment of the organs. 
Fig. 62.—Knee-chest position 
2. Reversed Breathing.—Lie on mat, on the back, knees 
bent upward, feet on floor (the “hook-lying position”). Arms 
at sides of the body, (a) Inhale slowly; (b) bend one knee 
upward until it presses on the abdomen forcibly, and exhale; 
(c) replace foot on mat. Inhale. Repeat the movement, 
alternating knees. 
3. Trunk-circling. — Stride sitting (preferably on the 
plinth), hands on the hips, bend trunk forward from the hips, 
swing sideways and circle backward, to first position. Same 
to the other side (Fig. 63). 
4. Trunk-twisting.—Starting position the same as in the 
preceding exercise. Twist trunk as far as possible, first to 140 
VISCEROPTOSIS 
right, then to left. The strength of the exercise may be 
increased by placing the hands on the neck. 
Note.—Exercises for posture, in the standing position, 
should be given. Voluntary contraction of the abdominal 
muscles practised while walking, holding good posture, is one 
of the best. 
Fig. 63.—Trunk-circling. 
The number of times each exercise shall be performed 
depends upon the judgment of the teacher as to the needs 
and ability of the individual. 
Exercises described in Chapter VII (numbers 10, 12, 13, 
14, 16, 17) will be found useful also. CHAPTER X. 
SCOLIOSIS. 
Scoliosis, or lateral curvature of the spine, is defined by 
Dr. Lovett as “a condition in which any series of vertebral 
spinous processes shows a constant deviation from the 
median line of the body, a deviation always accompanied by 
an element of twisting.” 
The word “scoliosis” is of Greek origin, meaning twisting 
or bending, and its application to this condition is of great 
antiquity, having been so used by Hippocrates, several 
hundred years b.c. 
Referring again to the anatomy of the human frame and 
to a discussion in an earlier chapter of the necessity of 
keeping the parts of this segmented mechanism in proper 
relation to one another and to the center of gravity, it will 
be seen that influences tending to disturb the equilibrium 
may be such that lateral deviations of the spine may result 
as well as deviations in the antero-posterior plane. In such 
cases the degree of distortion is even greater than in antero- 
posterior deflections. 
One need only visualize the flexible spine unstably bal- 
anced on the pelvis, and remember the close relation between 
the spine, ribs, sternum and shoulder girdle, to appreciate 
the asymmetrical adjustments which would result from any 
displacement of the spine laterally. Then it can be readily 
understood why lateral curvature of the spine is regarded 
as a serious condition and one peculiarly difficult of cor- 
rection. 142 
SCOLIOSIS 
The deviations which occur in the framework of the 
body will produce certain changes in the outline of the 
figure, such as an asymmetry of the two halves of the body, 
alteration in the position of the shoulders and scapulae, dis- 
placement of the trunk over the pelvis, and an apparent 
inequality of the hips. These and other slight abnormal 
variations of the body symmetry are usually the first things 
noticed and are regarded by the observer as original condi- 
tions rather than the results of underlying causes. It is often 
hard to convince a person that the prominent hip or high 
shoulder, for which advice has been sought, is of spinal origin. 
Lateral curvature is not usually accompanied by pain. 
This would occur only in severe cases where the deformity 
is so extreme as to cause pressure on the nerves, or to occasion 
ligamentous and muscular strain. 
Curves are named according to the regions of the spine in 
which their convexities occur, cervical, dorsal or lumbar. If 
involving parts of two regions, cervicodorsal, dorsolumbar. 
They are called right or left, corresponding to the direction 
of their convexities, and if more than one exists, the upper 
one is mentioned first: for example—“right dorsal, left 
lumbar curve.” 
CLASSIFICATION OF TYPES OF SCOLIOSIS. 
I. Postural, functional or total. 
II. Structural, or organic. 
Postural Scoliosis.—The terms postural, functional or total 
curve are synonymous and constitute the simplest form of 
scoliosis. Some authorities contend that this is not a true 
scoliosis, that it is merely a fault of posture which has become 
habitual and should be classed with faulty postures or be 
called a false scoliosis. CLASSIFICATION OF TYPES OF SCOLIOSIS 
143 
The postural curve is called “total,” as it is the deviation 
of the spine in its total length, to one side of the median line 
or the other, in the majority of cases, being to the left. There 
is no compensatory curve observable, and the untrained eye 
might not detect the deviation and consider the back normal. 
In this type, the spine can be straightened by suspension, 
Fig. 64.—Typical postural scoliosis. Left total 
or by lying prone in a horizontal position, and the individual 
is frequently able to correct voluntarily, after being shown 
how to make the proper readjustments. The characteristic 
conditions accompanying this deviation of the spine to the 
side are as follows: 
1. Displacement of the trunk over the pelvis toward the 
side of the convexity. 144 
SCOLIOSIS 
2. The shoulder and scapula on the side of the convexity, 
probably high. 
3. Thorax and shoulder girdle on the concave side twisted 
backward, making the corresponding scapula prominent. 
4. The angle made by the arm with the waist (called the 
“arm-waist angle”) is less on the convex and greater on the 
concave side. 
5. Hip on the concave side is prominent. 
Structural Scoliosis.—This is a more serious condition, for 
structural changes have actually taken place in the bones 
and tissues. It has been found that under pressure, bones 
adapt themselves to altered positions through changes which 
take place in the bone substance itself, hence the gravity 
of the condition, and the almost unsurmountable difficulty 
to be faced in correction. 
Adaptive changes also occur in the muscles and ligaments, 
and the curve cannot be straightened voluntarily nor be 
entirely corrected in the hanging or the “prone-lying posi- 
tion,” as was possible in the case of the postural curve. There 
are varying degrees of severity, from the slight flexible curve, 
with little alteration of body symmetry, through a diversity 
of stages, to the fixed structural scoliosis, with marked 
changes of contour and extreme deformity. In the advanced 
stages complete correction should not be expected. 
Structural curves are of two types: 
A. The simple structural involving one region of the spine 
only, and with no compensatory curve: usually dorsal or 
lumbar. This type should be in no way confused with the 
“total” curve, previously described, which is always postural 
and involves the entire spine. 
B. The compound structural curve is the form more fre- 
quently seen. It involves two or more regions of the spine, 
and is usually double, though it may become triple, one CLASSIFICATION OF TYPES OF SCOLIOSIS 
145 
curve compensating another in the effort to preserve the 
equilibrium. 
It is difficult to give a typical picture of the adjustments 
which will be found accompanying a structural scoliosis. 
No two individuals are exactly alike. The type and stage 
of development of the curvature, as well as the type and 
Fig. 65.—Typical compound structural scoliosis (right dorsal, left lumbar) 
flexibility of the individual, combine to produce ever-vary- 
ing and often most surprising results. In general, however, 
it will be noted: 
1. The spine will be curved laterally in two or more regions. 
2. There will be a prominence in the region of each con- 
vexity (due to “rotation”). 146 
SCOLIOSIS 
3. Marked difference in the height of the shoulders—the 
one on the side of the dorsal convexity, probably high. 
4. The scapulae will be displaced both as to height and 
inequality of distance from the spine. 
5. The arm-waist angle will be greatly increased on the 
side of the lumbar concavity and the hip on the same side 
will be markedly prominent (Fig. 65). 
The structural scoliosis may, and frequently does develop 
from the postural curve. For this reason, the postural 
curve should be watched with apprehension, for after it 
has increased to a certain point, the disturbance of balance 
is such that an effort is evidently made by the organism to 
preserve the equilibrium. An attempt is made to square the 
shoulder girdle keeping it in line with the pelvis, and to 
maintain the position of the head in the median line of the 
body; the spine yields at some point, a compensatory curve 
results, and the beginning of a compound structural lateral 
curvature is established. 
Two important factors to be considered in every case of 
structural scoliosis are the lateral deviation, and the rotation 
of the spine. These always occur simultaneously although 
they may vary in degree. 
Lateral deviation of the spine differs from lateral bending 
in that it is the bending of the spine on itself, with the head 
held in the median line. 
Rotation is the turning on a vertical axis of all the vertebrae 
affected by the curve, the amount for each vertebra differing, 
the maximum being at the greatest convexity of the curve. 
The explanation of rotation is that the bodies of the vertebrae 
support most of the weight of the trunk, and when the spine 
begins to bend laterally, compression on the concave side 
results, the bodies turn away from the line of weight, the 
ligamentous attachments of the spinous and transverse proc- CLASSIFICATION OF TYPES OF SCOLIOSIS 
147 
esses are stronger than those of the bodies and tend to hold 
them in position, so the bodies turn in the line of least 
resistance, which is always in the direction of the convexity 
of the curve. 
Fig. 66.—Diagrammatic representation in horizontal plane of “rotation,” 
showing displacement of vertebra by combined lateral deviation and rota- 
tion. B, body of vertebra; T, transverse process; P, spinous process; R, 
ribs; S, sternum; C, cartilages. 
As the ribs are attached to the bodies and transverse pro- 
cesses of the vertebrae, any alteration in the position of the 148 
SCOLIOSIS 
latter, especially such as that produced by rotation, will 
result in a marked change in the position of the ribs and 
consequently in the contour of the thorax, which will be 
fuller posteriorly on the side of the convexity and depressed 
on the concave side (Fig. 66). As may be seen from this 
diagram the rotation “compensates” or makes less apparent, 
the lateral deviation, and that for this reason the distortion 
of the trunk frequently may appear greater than the line 
of deviation of the spinous processes would seem to warrant. 
If rotation is present as the accompaniment of a curve in 
the lumbar region, there will be a fulness on the convex side 
occasioned by the erector spinse muscle which, overlying 
the lumbar vertebrae, is consequently thrown into prominence. 
Kyphoscoliosis.—In connection with a structural scoliosis, 
a marked kyphosis is sometimes associated. The combina- 
tion of these conditions results in considerable deformity. 
It is given the name of kyphoscoliosis. 
PATHOLOGY. 
Scoliosis is not a disease of the spine, but the result of 
faulty growth. The condition is not regarded as pathological 
until it becomes structural. In a functional curve, as the 
name implies, the difficulty is functional and no structural 
changes have taken place. In a structural scoliosis the 
alterations which occur in the bones and soft tissues vary 
from a slight degree, to those extreme conditions which 
produce gross deformity. 
The intervertebral disks are among the first structures to 
show adaptive changes. They become wedge-shaped: thin 
on the concave side of the curve and thick on the convex. 
The vertebrae also assume a wedge-shaped appearance, PATHOLOGY 
149 
thinner on the concave side and thicker on the side of the 
convexity. In severe cases the bony substance becomes 
twisted as well. 
Fig. 07.—Scoliotic spine from the Dwight collection of abnormal spines in 
the Warren Museum. 
The ribs bulge and increase in angularity on the convex 
side because of “rotation,” while on the concave side they 
tend to spread out toward the sternal end. This alters the 150 
SCOLIOSIS 
entire shape of the thorax. The sternum remaining a fairly 
fixed point, the result is a prominence of the chest in front 
diagonally opposite to the rotation posteriorly, and a corre- 
sponding depression of the chest and back on the opposite 
sides (Figs. 66 and 67). 
The scapulae become altered in position, and sometimes in 
shape as well. In extreme conditions even the bony pelvis 
is distorted. 
It follows necessarily that the organs enclosed in the 
thoracic, abdominal and pelvic cavities will accommodate 
themselves to the altered conditions. When displaced to 
a considerable degree their functions may be more or less 
interfered with. The heart and lungs are earliest to suffer, 
and it is usual to find poor respiration accompanying a 
scoliotic condition. The heart is not only crowded out of 
place, but is also directly affected by the insufficient breath- 
ing and a lowering of the general vitality is probable. 
The ligaments make adaptive changes, either becoming 
thicker and shorter, or thinner and longer. This results in 
unequal flexibility. 
The muscles are thrown out of their normal positions and 
their action altered. They may also suffer from fatty or 
fibrous degeneration. 
Summary.—Structural scoliosis is of diverse types, con- 
fined to one region of the spine with a small or great amount 
of rotation, or may involve two or three regions. From 
statistics gathered in the observations of patients during 
several years at the Children’s Hospital, Boston, the fre- 
quency of the occurrence of the several types was as follows: 
Single structural were not as common as compound struc- 
tural; of these, the dorsal type was most frequent, and the 
single lumbar less so. Of the compound structural, the 
right dorsal-left lumbar occurred more often than the left ETIOLOGY 
151 
dorsal-right lumbar and of the triple curves, the left cervical- 
right dorsal-left lumbar was more often seen. Of the total 
or postural curves the majority were to the left. 
ETIOLOGY. 
As we have already demonstrated, scoliosis is a lateral 
deviation of the spine from the median line, resulting in 
readjustments of the two lateral halves of the trunk so as 
to destroy their symmetry. As in our study of the etiology 
of faulty antero-posterior postures, in order to arrive at 
any sort of conclusion regarding the factors causing such 
a condition as scoliosis, it is necessary to pursue much the 
same lines of investigation. All those elements in the 
environment of the individual which might exert an influence 
upon symmetrical growth should be reviewed, and also the 
general condition of the organism which would cause it to 
succumb to or resist such influences must have careful con- 
sideration. 
A primary factor in all cases is the frequent assumption 
of one-sided positions that are persisted in until habits are 
formed and permanent adjustments take place. These 
abnormal attitudes may be traced to various causes. 
Physical Defects.—It is very generally recognized that a 
large group of malpositions result from some underlying 
structural or physical defects that are often of congenital 
origin. For instance, a child may be born with a deficient 
or an accessory rib, with an elevated scapula or a deformed 
vertebra. These and other abnormalities would produce 
an asymmetry in the bony framework which in all prob- 
ability would not be manifested until the upright position 
in walking was assumed, when the superincumbent weight 
exerting its influence and bearing unevenly upon the sup- 152 
SCOLIOSIS 
porting structures would induce constant faulty positions. 
It was thought formerly that these congenital defects were 
rare, but since there has been a more general use of the 
roentgen ray, surgeons are finding them so frequently that 
they conclude that many cases of structural scoliosis may 
be traced to them, and are using the roentgen ray as part 
of the routine examination. 
There are other physical defects—not of congenital origin- 
winch may also be the underlying causes of positions of 
asymmetry such as the loss of an arm or leg, or a short leg 
necessitating the one-sided use of the body. Any static 
interference with the balance of the body, which tends to 
alter the position of the spine in its effort to preserve the 
equilibrium, may thus produce lateral deviation and form 
the basis of a scoliosis. 
Undoubtedly the mechanical distortion of the body fre- 
quently has its origin in some underlying physical defect in 
the bony framework. The same governing principle applies 
to the influence which may be exerted by other physical 
defects, though each of them may act in a different way. 
While there are a large number of such conditions, we will, 
however, briefly mention only a few. These are: Empyema, 
causing a contraction of the thorax on one side; serious 
burns or injuries resulting in scars which contract the tissues. 
Chronic appendicitis causing the assumption of a one-sided 
position to relieve the pain may be mentioned. Organic 
heart disease would likewise cause similar adjustments. 
Again, defects of hearing and vision also cause the frequent 
assumption of one-sided positions. Among the predis- 
posing causes there is none that may exert a greater influ- 
ence than infantile paralysis, which results in loss of muscle 
power with the consequent lack of support and alteration 
of the mechanics of the body. ETIOLOGY 
153 
An interesting and reasonable theory has been advanced 
recently to account for some of the extreme cases of 
scoliosis, for which no sufficient cause has heretofore been 
found, nor any satisfactory treatment suggested. This 
theory is that some of the intrinsic muscles, important in 
holding the spine erect, have been paralyzed. These inert, 
useless muscles are the oblique extensors and allied groups 
which form a network of muscular fibers connecting the ribs 
and vertebrae posteriorly, and it logically follows that no 
amount of training of the large body muscles would avail 
to stabilize the spine under such circumstances. 
Many lateral curvatures of the spine have no apparent 
underlying physical or structural defects acting as causes. 
They must be sought in the surroundings and habitual acts 
of the individual. These are so numerous and of such varied 
character that it would be difficult to enumerate and classify 
them. For the sake of convenience, however, they may be 
included under the term “ environment.” 
In addition to the consideration of the factor of frequently 
assumed faulty positions, attention must be also directed to 
the condition of the bony structure, the muscle tone and the 
influence exerted by the superincumbent weight. 
School Environment.—Having discussed at length the prob- 
lem of the growing child and the bearing of school life on 
posture, it may be sufficient to call attention here to the fact 
that all the conditions pertaining to fatigue, overexertion, 
nervous tension, and so on, will exert the same pernicious 
influences upon the formation of a one-sided posture. In 
fact, many curves of the postural type are probably started 
because of these conditions. 
One writer has referred to school rooms as “ the factories 
of scoliosis.” Perhaps this statement is a little strong, never- 
theless it serves to draw attention to the fact that this is a 154 
SCOLIOSIS 
subject for serious consideration. When seated for lengthy 
periods, and often at desks not at the proper height, attitudes 
commonly assumed are twisted positions, leaning forward 
with one elbow resting on the desk, or sitting on one foot. 
Some interesting studies made in regard to this showed the 
following results r1 
In all grades, only one-third as many girls as boys slide 
down in seats. 
Leaning on one elbow begins in lowest grammar and 
increases in higher grades. Twice as frequent with girls as 
boys. 
Sitting on one foot more common with girls. 
The complexity of postures increases from lower to higher 
grades. 
A favorite attitude in high grammar grades consists in 
crossing the right leg over left, bracing the leg in desk irons 
at left and leaning on left elbow. 
1484 pupils observed: 
Correct position, 13 per cent; 
Stooped forward, 40 per cent; 
Sliding down in seats, 13 per cent; 
Twisted, 23 per cent; 
Unclassified poor postures, 11 per cent. 
As these observations were made some years ago, it is to 
be hoped that conditions have been bettered, by improved 
seating and attention to other phases of the problem, so that 
a higher norm of good posture would be found. However, 
we can be certain that much still remains to be accomplished 
in the school room. 
For the purpose of particularly applying here what has 
been said elsewhere, and at the risk of reiteration, it may be 
1 Observations made by Miss Lillian Towne, Boston. ETIOLOGY 
155 
Fig. 68.—This habit was persisted in for several years. 
Fig. 69.—Resultant: left total scoliosis with prominent right hip. 156 
SCOLIOSIS 
stated again in substance that carrying books to and from 
school is probably more pernicious in the formation of 
Fig. 70.—Carrying school books in bag suspended in this manner tends to 
produce left total scoliosis. ETIOLOGY 
157 
lateral, than of antero-posterior faulty postures. The most 
common way for girls to carry their books is to rest them 
upon one hip, and always the same hip, until sometimes a 
regular shelf is formed, and the spine is pushed to the 
Fig. 71.—Characteristic attitude, “standing on one foot.” 
opposite side. Many children use a bag attached to a 
long strap which passes diagonally across the body from 
one shoulder to the opposite hip, creating a one-sided pull 
upon the trunk and spine. It is also injurious to carry a 158 
SCOLIOSIS 
bag constantly in the same hand, and to allow it to drag 
down on the shoulder. The solution, as before mentioned, 
is to have two sets of books so that none need be carried, 
or to insist on having the books carried in such a way that 
the weight may be borne symmetrically (Figs. 68, 69 and 
70). In some schools pupils are directed to alternate the 
side on which books are carried from day to day. 
The habit of standing on one foot, allowing the weight to 
sink down, and throwing out one hip, is quite universal, 
both with children and adults. It is usually the same foot, 
and in these conditions tending toward postural curva- 
tures will correspond to the already established “line of 
least resistance” and adds its influence toward increasing 
an undesirable condition. A poor antero-posterior posture 
is usually associated with the postural scoliosis. Both 
conditions would be fostered, especially by the above- 
mentioned habit (Fig. 71). Flexibility under such stress 
becomes unequal, the spine bending much more easily to 
the concave side there will never be any inclination to bend 
to the opposite side. Ligaments and muscles quickly adjust, 
the muscle sense of the symmetrical position is lost and the 
child is well started with a postural lateral curvature of 
the spine. 
Clothing.—Attention has already been directed to the 
influence which uncomfortable or improperly adjusted 
clothing may exert in the production of errors of posture. 
The underwaists worn by many children with their per- 
nicious puir on the shoulders, and improper shoes, causing 
a tendency to stand on one foot and relieve discomfort, 
may be mentioned. Tight belts are harmful when there 
is a lateral curve in the lumbar region, which gives a deepened 
waist on the concave side. The belt will press in, still 
further increasing the hollow, while on the convex side there 159 
ETIOLOGY 
is firm resistance, which becomes a point of leverage from 
which the pull on the less resistant side will be made 
(Fig. 72). 
Habits of Occupation and Recreation.—The school problem 
must be dealt with more universally than any of the habits 
of occupation, as it enters into the life of every child. Some 
of the evils of child labor are the vicious environment to 
which the child is subjected during the period of growth; 
Fig. 72.—Showing the effect of a belt on a slight curve. 
the confinement for many hours a day in unhygienic sur- 
roundings, seated many times in twisted attitudes; the use 
of foot power, almost always on only one side; or standing, 
as in factories, using one arm to perform the same recurring 
task. The newsboy, carrying a large bundle of papers always 
in the same way, day after day, often develops a serious 
scoliosis. The “little mothers” of the tenements, carrying 
younger brothers or sisters, propped usually on one hip, and 160 
SCOLIOSIS 
bearing a weight far beyond their strength, furnish another 
example. An interesting illustration is found among the 
Venetian gondoliers, who themselves recognize that they 
are one-sided. Holding the sweep with the left hand higher 
than the right, right leg extended backward and trunk bent 
forward while the arms swing downward, the constantly 
recurring position results in a left dorsal-right lumbar curve, 
and has been called “the gondolier scoliosis.” 
A similar condition might be produced by constant 
paddling in a canoe, and there are certain sports which 
should be prohibited or modified for an individual with a 
lateral curvature. For example, paddling with left hand 
high and a sweep to the right accentuates a left total curve. 
The reverse position would act as a corrective. A lad with 
a right dorsal-left lumbar scoliosis with marked dorsal rota- 
tion was observed not long ago, and it was found that much 
of his time out of school hours was spent playing baseball — 
the position he assumed “at the bat” accentuating in a 
marked degree all the deformities of the curvature. Hence 
the importance of keen observation of “ contributory causes.” 
Muscular Weakness.—Notwithstanding certain previously 
mentioned conditions all tending toward the continued 
assumption of faulty postures, nevertheless their effect on an 
individual will depend upon the degree or extent of that 
particular individual’s resistance. If the muscles are strong, 
they will exert much less influence than if the muscles are 
weak. A strong, sturdy physique will withstand influences 
which would quickly distort a weak and flabby one. 
It might be well to draw a line of demarcation here, between 
(1) the development of a scoliosis from faulty postures caused 
by some physical or structural defect, and (2) that which is 
produced from factors of environment. In the first class 
there are mechanical disadvantages that cannot be con- ETIOLOGY 
161 
trolled, and a severe type of scoliosis is almost sure to result 
with surprising swiftness. Those in the second group develop 
more slowly, and usually not to such an extreme degree. 
Occurrence.—The frequency of occurrence of scoliosis in 
boys and girls has been discussed at length; some authorities 
contending that it is more frequently found among girls than 
boys, for the reason that, as a general rule, from a constitu- 
tional standpoint they are not as strong as boys, and also 
that their muscular development is less. This, added to the 
fact that the bony structure of girls grows faster than that 
of boys at the period of adolescence, would seem to add 
weight to the theory. Girls are also more inclined than boys 
to be sedentary in their habits at this age. This, however, 
is not true in all cases; for there is the strong, athletic type 
of girl, and the weak, delicate boy who prefers to sit at home 
curled up over his books. 
After all, through the establishment of higher standards 
of health and the emancipation of woman from past tradition 
which hampered her, the term “weaker sex” has logically 
become no longer applicable, so that it may be safely asserted 
that the terms “strong” and “weak” are individual rather 
than sex attributes. Based on this theory, it follows that 
lateral curvature of the spine will occur with equal frequency 
in both boys and girls. 
Possibly the reason that a larger number of girls appear to 
be affected by this deformity is because attention is more 
frequently drawn to asymmetry of the figure in girls from the 
esthetic standpoint, and consequently they are brought more 
often to the notice of physicians and teachers of physical 
education for correction. This answers the argument of 
those who claim that all are equally affected. 
Depleted Strength After an Illness.—This is a frequent cause 
of the conditions under consideration, the individual being 162 
SCOLIOSIS 
unable to stand erect because of the muscular weakness 
which allows the spine to sag again and again until a habit 
posture is formed which, if continued, will become permanent. 
In cases of muscular weakness—the muscles having lost the 
ability to support the structures properly—the strain is then 
brought upon the ligaments which in time become stretched, 
and the muscles become still weaker through disuse. It is 
the gradual yielding of “the outposts of our citadel.” 
What is said by Dr. R. Tait McKenzie in this connection 
is so pertinent that we quote from him as follows: “The 
integrity of the spine is protected against the onset of 
deformity by three lines of defense of increasing strength: 
(1) The muscles forming an advance mobile series of outposts 
brought into service in relays, powerfully but intermittently; 
(2) the ligaments more resistant, but less mobile, require 
long-continued but persistent attacks to overcome their 
normal protective action; (3) the bones which may be com- 
pared to a citadel, yielding to the influence of deformity only 
after the other two lines have long since been carried.”1 
Soft Bone.—If faulty postures were constantly assumed 
when the resistance of the underlying structures is great, 
as in adult life, after the full growth of the bones had been 
attained, probably no harm would result. On the contrary, 
during the period of the growth of the child the bones are 
soft and plastic and easily molded into abnormal shapes by 
influences such as have been indicated. 
There is also a pathological condition known as rickets, 
usually the result of poor nutrition, where there is a lack of 
lime salts, resulting in abnormally soft bone, which often 
underlies some of the severe forms of scoliosis. Osteomalacia, 
another condition of soft bone, may be present in some cases. 
1 McKenzie, R. Tait: Exercise in Education and Medicine. ETIOLOGY 
163 
Superincumbent Weight.—Another influence which must be 
considered of much importance is that of the superincumbent 
weight of the head and arms. This weight of itself does not 
tend to distort the spine, but on the contrary it is noticeable 
that those races among whom it is customary to carry heavy 
weights on the head are noted for their erect bearing. In 
some of the Oriental countries it is known to be a mark of 
the coolie or working class to have this noticeably erect 
posture, and for that reason, not to be desired for those of 
higher caste. 
When the spine is straight and properly adjusted to the 
center of gravity, superincumbent weight tends to keep it 
still more erect. If there is any deviation to the side, then 
this weight being thrown out of alignment with the center 
of gravity becomes a powerful factor in increasing the dis- 
tortion. This is important, as it is exerting its influence 
constantly during the daily life of the individual. 
The study of the etiology of scoliosis must necessarily be 
cumulative in character, and consideration must be given 
to many contributing causes, which may be grouped as 
follows: 
I. Malpositions. 
1. Structural or physical defects. 
A. Congenital. 
B. Acquired. 
2. Environment. 
School, occupation, clothing, etc. 
II. Conditions of soft bone. 
1. Period of growth. 
2. Pathological conditions (rickets, osteomalacia). 
III. Muscular weakness. 
IV. Superincumbent weight. 164 
SCOLIOSIS 
It has been briefly and comprehensively summarized by 
Dr. E. G. Brackett1 as follows: 
Physical defect 
Habits of position 
Growing periods 
(plastic stage) 
Abnormal bone 
(rickets) 
Faulty attitudes 
Lateral curvature. 
Soft bone 
OLD THEORIES. 
Some of the old theories in regard to the etiology of scoliosis 
are of interest, not only as showing the stages through which 
the study of this subject has passed, but also from the fact 
that many of them were merely imperfect, not entirely 
erroneous. Certain of these emphasized as important those 
elements which we now regard only as minor factors in the 
causation or increase of the condition. Cause and effect 
were often confused, and abnormalities resulting from 
scoliosis were mistaken for the cause. 
Among the earlier writers on the subject, mention should 
be made of Hurter and Engell, who considered the under- 
lying cause entirely due to abnormal or asymmetrical develop- 
ment of the vertebrae. 
Guerin advanced the theory that spasmodic muscular 
action pulled the spine out of position in various regions. 
His treatment for correction was to cut muscles and ligaments 
on the concave side. This was a case where the result was 
mistaken for the cause. 
Eulenberg thought that the important factor was muscular 
weakness on one side, with a resultant disturbance of balance 
and distortion of the spine. 
1 Reference Handbook of the Medical Sciences. EXAMINATION FOR SCOLIOSIS 
165 
Rosa and Volkman claimed that the superincumbent 
weight of the body was the great predisposing cause. 
Many other theories have been advanced from time to 
time. Present-day authorities agree that the reason for the 
development of scoliosis is not due to any one cause, which 
is applicable to all, or even the majority of cases, but to the 
influence of many factors. A difference of opinion exists 
only in regard to the relative importance which each may 
have as a primary or contributory cause. For example, some 
believe that the schools should be blamed to an extreme 
degree; others lay not so much stress upon this, and there 
are those who contend that the majority of cases are of con- 
genital origin or due to rickets. It is still a subject for 
earnest thought and investigation. 
EXAMINATION FOR SCOLIOSIS. 
The preparation of the individual should be the same as 
that previously suggested for the examination of the antero- 
posterior conditions. However, we may emphasize here the 
following essentials: 
1. The back should be fully exposed so that the relation 
of the trunk to the legs can be seen. 
2. Since an examination through any part of the clothing 
is absolutely futile, whenever possible the removal of all 
apparel should be insisted upon. A loose robe can be thrown 
over the shoulders and be easily adjusted so as to expose only 
those parts necessary for observation. 
We believe it is very pertinent to state at this point that, 
owing either to the careless methods of those responsible 
for making examinations, or their failure to realize its neces- 
sity, or to the ignorance of parents concerning its importance, 
a prejudice has existed and still exists against allowing any 166 
SCOLIOSIS 
examination of a pupil “undressed.” But notwithstanding 
that this prejudice constitutes one of the greatest handicaps 
in the detection and correction of abnormal conditions among 
pupils in the public schools, nevertheless, through the earnest 
efforts of the teachers of physical education, this objection 
is being overcome, so that many schools now allow the pupil’s 
back to be exposed for examination. 
A pupil not infrequently asserts that an examination is 
unnecessary and will tell the examiner that all that is wrong 
is a high shoulder, and that she would like a few exercises to 
correct it. Such an assertion should never be accepted in 
lieu of an examination, nor exercises be given unless the 
actual condition has been seen. If by a persuasive and clearly 
interested manner such a girl can be so influenced as to 
desire and accept a thorough examination, it is within the 
limits of probability that a lateral curvature of the spine 
may be uncovered. 
It is requisite that the pupil be placed for the examination 
so that the light will fall evenly on the back without any 
cross-shadows. The examiner’s position should be such that 
the eye is about opposite the center of the back, in order to 
get the most advantageous view of the whole condition. The 
pupil should stand at ease with the weight equally on the 
two feet and the arms hanging at the sides of the body. It 
is often difficult to estimate a postural curve at once, as a 
person with a flexible spine under excitement or embarrass- 
ment of an examination may assume a variety of attitudes. 
The examiner should take plenty of time before making a 
decision, so as to be reasonably sure of the habitual condition. 
The deviation of the spine may be noted by marking the 
line of spinous processes which can be felt through the skin, 
but care must be taken to mark exactly over each one and EXAMINATION FOR SCOLIOSIS 
167 
not push the skin to one side. Other landmarks may be 
indicated if desired, such as the borders and angles of the 
scapulae. A useful sort of pencil for use is an ordinary eye- 
brow pencil, obtainable at any drug store. 
The eye should be trained by careful observation to recog- 
nize quickly lines of symmetry and asymmetry, so that the 
Fig. 73.—Front view showing displacement of trunk in a left total scoliosis, 
teacher will be able to decide promptly that the pupil is 
or is not normal. This is the initial step in an examination, 
which should be followed by a more detailed observation as 
follows: 
I. Examine from the side, to detect any deviations in the 
antero-posterior plane. 168 
SCOLIOSIS 
II. Examine from the front. Frequently the body dis- 
placement is more apparent in this position. Distortion of 
the thorax should be noted, as to bulging, or depression of 
the ribs, and the regions involved. The breasts should 
be on a horizontal plane and a position of one relatively 
higher or lower shows spinal deviation. Position of head 
and lines of neck should be observed (Fig. 73). 
III. Examine from the back. 
1. General hygiene and muscle tone. 
2. Flexibility: (a) General; (b) local (note regions where 
limited). 
3. Feet. Any abnormalities. Arches. 
4. Hips. Inequalities in prominence or height. 
5. Arm-waist angle compared on both sides. (Inequality 
indicates body displacement.) 
6. Scapula?; unequal in height; unequal in distance from 
spine; relative prominence. 
7. Height of shoulders; equal or unequal. 
8. Lateral displacement of trunk over pelvis. This 
can be estimated by erecting a perpendicular from the 
gluteal fold. 
9. Asymmetry of the lateral halves of trunk. 
10. Lateral deviation of the spine as shown by line of 
spinous processes. 
(a) Regions of convexities. 
(b) Direction of convexities. 
(c) Type: Postural; structural. 
11. Rotation: Amount; location. 
Note.—The test for rotation is to have the pupil bend 
forward, knees extended, in the so-called “Adams position,” 
which is a rounding over of the entire back with the arms 
falling forward, relaxed. Thereby the rotation is increased 
and the condition can be readily observed by placing the EXAMINATION FOR SCOLIOSIS 
169 
eye at the same level and looking across from back to front, 
in the horizontal plane (Fig. 74). 
It is advisable to examine the pupil not only in the erect 
position (especially in a structural condition), but also when 
lying prone—with arms at the sides of the body. While in 
this position it is well to exert manual pressure on the con- 
vexities and to observe the effect on the back. Finally, the 
individual should hang by the hands from a horizontal bar. 
The amount of correction accomplished by these tests will 
enable one to estimate the degree of the structural change, 
Fig. 74.—Banding forward in the “Adams position,” to show rotation. 
the amount of flexibility, and the possibilities of improve- 
ment. A postural curve will entirely straighten under these 
tests. 
In the standing position, we see the body as ordinarily 
carried, with the curves at their maximum of distortion, 
because the factors of fatigue, the influences of gravity, 
and the superincumbent weight are then present. While 
relaxed in the recumbent position all abnormal curves may 
disappear, because the stress incident to the maintenance 
of the erect posture has been removed. 170 
SCOLIOSIS 
The distinction must always be made between a high and 
a prominent hip, as they are not synonymous terms. The 
expression “high hip” is almost universally used to designate 
an apparent inequality, but in reality is of much less fre- 
quent occurrence than the prominent hip. 
Fig. 75.—Prominent hip. (Result of sagging of trunk over pelvis.) 
The high kip is a tilting of the pelvis occasioned by an 
actual difference in the length of the legs. The prominent 
hip is caused by the displacement of the trunk over the pelvis 
toward the convexity of the curve. On the concave side, 
the waist becomes sunken, causing a deep angle over the EXAMINATION FOR SCOLIOSIS 
171 
crest of the ilium, and the appearance known as the 'promi- 
nent hip results. The importance of understanding this 
difference will be seen to have a direct bearing upon methods 
of correction, for while a prominent hip is the result of a 
spinal deviation a high hip is a cause (Figs. 75 and 76). 
Fig. 76.—High hip. Produced by inequality in length of legs 
In order to ascertain the length of the legs in the case of a 
high hip, measurements by tape can be taken, lying on the 
back, and the distance from the antero-superior spine of 
the ilium to the tip of the internal malleolus noted. This 
has the disadvantage of the inaccuracy of all surface 172 
SCOLIOSIS 
measurements due to slipping of the skin. A good method 
of finding the relative difference in length of legs is to have 
on hand several blocks of wood, of graded heights varying 
from one-eighth to one inch in thickness, and placing one 
or more of them under the foot on the side of the short leg 
until the pelvis becomes even. A wooden caliper with 
spirit level attached is useful in determining inequality by 
adjusting its arms over the iliac crests. 
This defect of the hip should be mechanically corrected 
by a lift of requisite height attached to the heel of the shoe; 
or better still by the use of a cork insole of the proper height 
at heel, tapering down to the ball of the foot. This can be 
slipped into any shoe, and is light and comfortable to wear. 
RECORDS. 
After an examination has been made, the results should be 
recorded and the various conditions represented in as graphic 
a manner as possible. Different methods and devices are in 
use for this purpose. The attempt to make records in terms 
of inches has been practically discarded. Measurements on 
the skin, by use of a plumb-line from which deviations of 
parts of the spine could be indicated, are subject to so many 
variations that they are considered of questionable value. 
Many machines have been invented, some of them use- 
ful. The best known of these are the Schulthess and the 
Zander machines. The drawback to much of this apparatus 
is that it is usually complicated, and too expensive to be 
universally available. For making outline tracings, the 
pantograph is graphic and easily obtainable. Its principle 
is used extensively in many machines. 
One method of recording the deviation of the spine is to 
attach a strip of adhesive plaster, three inches wide, to the RECORDS 
173 
back over the spine all the way from the seventh cervical 
to the gluteal fold and to mark the line of spinous processes 
as they are felt upon this. 
An easy way of obtaining a representation of the rotation, 
is by the use of a flexible lead tape, which is pressed around 
the back at the point of maximum rotation, and this outline 
is then transferred to cardboard. The distance down from 
the seventh cervical at which this is taken should be noted, 
and also the position of the spinous process indicated. Later 
records can be made and when superimposed any change 
observed. 
The schematograph may be used to advantage for giving 
a general picture of the condition. The manner of making 
the drawing is the same as described in a previous chapter 
for the antero-posterior records. This has the advantage of 
being cheap and rapid. 
Photography is perhaps the best means of record at our 
command. It gives the most accurate representation, and 
is very quick. Care must be taken that the individual 
shall stand in a plane parallel to that of the camera; that 
there shall be no twist, and that the light shall fall evenly. 
A rubber stamp of the outline of the back as well as of the 
profile of the body is obtainable and useful for giving a dia- 
grammatic delineation. All the asymmetrical features may 
be indicated speedily on the symmetrical outline stamped. 
This is especially valuable for the teacher’s use as a quick 
reminder of existing conditions1 (Fig. 77). 
In addition to these records there should be noted the age, 
sex, height, weight, condition of the heart, type of individual, 
history of past disease, present physical condition and the 
habits. So far as possible information should be gathered 
1 Diamond Union Stamp Works, 175 Washington Street, Boston, Mass. 174 
SCOLIOSIS 
tending to shed light upon causes, which would be a guide 
in the process of correction. 
A roentgen-ray picture is desirable, especially in structural 
cases. 
Fig. 77.—Rubber stamp for records, 
PROGNOSIS AND TREATMENT. 
Any lateral deviation of the spine should be regarded as 
a danger signal and as a condition demanding attention. 
In considering the possibilities of the correction of lateral 
curvature of the spine, they may be grouped as to severity 
thus: 
First degree—postural. 
Second degree—slight structural. 
Third degree—severe structural. 
Postural curvatures without treatment may remain as they 
are. No hard and fast prediction can be made regarding 
them. Some disappear entirely, but in many instances they 
progress and become structural. With treatment a postural 
curve should be entirely corrected. A child with a postural PROGNOSIS AND TREATMENT 
175 
curve who is not taking treatment should be kept under 
observation, and any increase of such a condition ought to 
awaken one to the danger attending its neglect, and treat- 
ment applied at once. Do not trust to the luck that a child 
will outgrow the condition. It is a dangerous policy. 
Structural curvatures in the young should always be 
regarded as serious, for they frequently increase, sometimes 
with startling rapidity, and may lead to great deformity. 
Therefore we cannot urge too strongly the danger of delaying 
treatment in cases of this nature. When slight and flexible, 
these curves may be greatly improved, and in many cases 
cured, by adequate and long-continued treatment. If of any 
severity, this calls for special exercises, if not daily at least 
two or three times a week during a long period of time, some- 
times for years. Some exercise should be kept up during the 
entire period of growth. This must be aided by the hearty 
cooperation of the pupil and family with the teacher, and 
supplemented by work at home. 
In the more advanced stages structural scoliosis cannot 
be cured, but may be improved, and usually can be arrested. 
When a scoliosis has advanced to the third degree and has 
become fixed, the bony structures cannot be altered, but 
exercises should be persisted in, as they will keep up the 
strength of the muscles, and prevent sagging of the back, 
which counts for a great deal in the appearance, comfort and 
activity of the individual. When the underlying cause is 
beyond the power of control, as is the case in infantile 
paralysis, it is almost impossible to prevent the advance 
of the condition no matter what means are employed. 
Persistent effort should be made, however, as lack of treat- 
ment would be disastrous. Relative to the treatment of 
structural scoliosis, one writer has said, “There is prob- 
ably no class of abnormal conditions which comes under 176 
SCOLIOSIS 
the eye of the speeialist which requires so much persever- 
ance.” 
If a condition seeming to be structural lateral curvature 
has been observed, the advice of an orthopaedic surgeon 
should be sought before the responsibility of giving exercises 
for correction is assumed. On most occasions it is advis- 
able to put the treatment into the hands of the specialist. 
Even in the case of a postural curvature of the spine, it is 
wise to have such supervision. A teacher of physical 
education should be informed of the name of a competent 
orthopaedic specialist in the locality, to whom pupils may 
be directed when necessary. 
To the uninitiated, it often appears that the treatment of 
scoliosis means a routine lesson, once or twice a week, and 
the performance of a list of exercises, with the responsi- 
bility laid upon the teacher to remedy the condition in some 
miraculous manner. It is to be hoped that not many 
parents are as unthinking as the one who asked the writer 
not long ago if a “cure” could be “guaranteed in ten lessons!” 
Exercise is important, but it is only part of a program which 
must be preventive, corrective, and sometimes retentive 
as well. 
Preliminary Factors in the Treatment.—In the first place we 
will reassert here the principle to which attention has been 
directed in a preceding chapter. It is this, The pupil must 
be induced to become interested to the extent of having 
“the will to do.” It should also be impressed upon parents 
that their cooperation is essential and that, even for the 
improvement of a postural condition, lessons must be carried 
out over a considerable period. 
After the lesson has been finished, exercises will be proved 
to have been of little value if the individual heaves a sigh of 
relief, sinks down on one foot, throws the hip into prominence, PROGNOSIS AND TREATMENT 
177 
and then walks out of the gymnasium in such a manner as to 
accentuate all the incorrect features of the condition. 
A background of health on which to build is essential to 
success. Hence all the factors of the environment should 
be studied and predisposing influences be eliminated. It 
is most important to look for vicious habits of standing and 
sitting. 
Mention has already been made of the influence of school 
conditions, and as long as these and other elements of the 
environment operate to handicap us in the treatment, just 
so long will we be unable to obtain the best results in the 
correction of lateral curvature of the spine. Therefore, 
it cannot be too strongly urged that a child with a scoliosis 
of any degree should be relieved of many of his burdens: 
that school requirements be reduced to a minimum, with 
plenty of time for rest and play; and that the business of 
life, for the time being, should be that of giving attention 
to the correction of the curvature. If these changes are 
promptly effected, progress will be greater, the result more 
speedily attained and more satisfactory in the end. Few 
parents, however, are willing to make such a “sacrifice” of 
time at school, and frequently the child is still further taxed 
by the addition of special exercises to an already overfull 
program. 
When treatment is conducted in sanitariums results are 
likely to be far more encouraging; for not only are daily 
lessons given, but the hygiene is controlled, pupils have 
plenty of fresh air, good food, sufficient sleep and recrea- 
tion, essentials of primary importance in treatment. 
Treatment by Exercises.—Having taken 'preventive measures, 
the corrective treatment by exercises should follow. This 
must be planned with reference to the type of curve: first, 
second or third degree, 
12 178 
SCOLIOSIS 
Here also the general health and strength of the individual 
should have consideration, likewise any condition noticed 
during the examination which may require a modification 
of the exercises. The heart should always be tested. 
The lines along which it is then essential to work are: 
1. For improvement of the general condition. 
2. Equalization of flexibility. 
3. Strengthening muscles. 
4. Readjustment of muscular control. 
In the treatment of all degrees of lateral curvature asym- 
metrical exercises are being used less than formerly and much 
attention is being given to training the pupil to assume the 
correct position as nearly as possible, and then by symmet- 
rical exercises strengthening the muscles to hold the position. 
The reestablishment of a desirable neuro-muscular control 
is thereby gained, which replaces the faulty coordinations 
of asymmetry. 
Type of Exercises for Postural Scoliosis.—A few exercises 
for improving flexibility should be given and then training 
(preferably before a mirror) for the symmetrical position. 
This is a very valuable part of the program. Time and 
again the individual is shown the proper adjustments. At 
first he is assisted by the teacher who touches lightly the 
maximum point of the curve, suggests the correction of the 
body displacement, calls attention to inequalities of the 
shoulders and so on, asking the pupil to take a position cor- 
recting these defects as nearly as possible. Then after a 
moment, in which to relax, he is instructed to take the posi- 
tion again, and finally to make an excursion around the 
room holding the improved position. Little by little the 
pupil “gets the feeling,” and if this effort is persisted in at 
other times much of the battle is won. 
A program should be planned for its hygienic as well as PROGNOSIS AND TREATMENT 
179 
for its corrective value. It should never be composed 
entirely of specialized exercises, but arranged with reference 
to its physiological effect on the entire body. 
Type of Exercises for Structural Scoliosis.—In giving 
exercises for the correction of a structural scoliosis, it is 
not considered advisable to increase the flexibility of the 
spine to too great an extent, unless some retentive apparatus 
is to be worn. Such increased flexibility permits the spine 
to sag out of position still farther, at times when the 
individual is unable to make the muscular effort necessary 
to counteract the ever-existing tendency. When it is 
advisable to work for flexibility in a condition of extreme 
stiffness, it will need to be done by the use of some sort of 
mechanical apparatus, of which there are many. These 
are used to a considerable extent in the gymnasiums of the 
orthopaedic surgeons and in hospitals where such work is 
done. Although applied in various ways these machines 
embody certain principles, mainly those of traction on the 
spine and pressure on the convexities of the curves. 
Forcible Correction by Plaster Jackets.—This method is 
used to some extent by all orthopaedic surgeons under 
certain conditions. A plaster jacket is applied to the 
patient who is placed for the purpose in a position of maxi- 
mum correction. This correction is obtained, in various 
ways, by suspension, or in some recumbent position, with 
the spine relieved of the weight. All supports of this nature 
must be worn for a certain length of time, amounting to 
years in many cases, and should be renewed frequently, 
at the discretion of the surgeon. They are made usually 
with openings, or “windows,” opposite the regions of the 
concavities, back and front, which permit expansion of the 
hollows through respiration. Pads of heavy felt can like- 
wise be inserted in such a manner as to exert still further 
pressure on the convexities. 180 
SCOLIOSIS 
After the condition has improved, this type of support 
may be replaced by a reviovable jacket, which may be made 
of plaster, leather, or celluloid, reinforced sometimes with 
steels and straps. Removable supports make it possible to 
exercise the muscles, which is most important. One of 
the disadvantages of the permanent support is the loss of 
strength through the inability of the individual to exercise 
the muscles concerned in holding the spine erect. 
Retentive Treatment.—Removable jackets and braces 
cannot be' depended upon to give much correction, but 
they are of value in holding the back in its best position 
and in preventing an increase of the deformity. Treatment 
combining exercises with the wearing of a removable sup- 
port has been widely used and has been found a fairly effec- 
tive means of dealing with structural scoliosis. 
Braces are sometimes worn, but are never very satisfac- 
tory. It is almost impossible to construct a brace in such 
a manner as to obtain the requisite leverage for pressure, 
without being so constricting as to cause great discomfort. 
The individual is thereby tempted to loosen the straps and 
to make adjustments for comfort which allow the brace to 
slip, and eventually it is liable to do more harm than good. 
Apparatus advertised in stores or in the press should be 
avoided. A brace, or support of any kind for the correction 
of such a complicated condition as scoliosis, should be fitted 
to the individual by a skilled surgeon. 
Operative Measures.—For some time surgeons have 
operated occasionally on the distorted bones in cases of 
extreme deformity, but this has not been done to any great 
extent until within the past few years. An operation origi- 
nated and performed by Dr. Hibbs, of the New York Ortho- 
paedic Hospital, seems to mark the opening of a new field of 
treatment in certain cases. After the deformity has been THE PAST HISTORY OF SCOLIOSIS 
181 
corrected to the greatest possible degree, the operation is 
done. By it a fusion of the vertebrae is obtained, eliminating 
motion in the joints of the deformed area, thus preventing 
the progress of the deformity. This forms a sort of natural 
brace, as the spine remains fixed in the corrected position. 
This treatment has special advantages, as it eliminates 
for many individuals the long-continued wearing of braces 
or jackets, removes much mental anxiety, and prevents an 
increase of the deformity. 
An extreme scoliosis is one of the most distressing of 
burdens to be borne, shadowing many lives, sometimes 
even from early youth. The wearing of heavy apparatus, 
the distortion of the figure, long-continued corrective exercise 
treatments, year after year, and the ever-deferred hope of 
recovery, all make us wish for some far better means for 
correction than any that are known and available at the 
present time. 
Summary. 
In the experience of those who have given the subject 
careful consideration, the treatment of scoliosis may be 
resolved into three lines of procedure, one or more of which 
may be necessary, depending upon the condition to be cor- 
rected. 
1. Exercise. 
2. Use of some sort of apparatus (corrective or retentive). 
3. Operative measures. 
THE PAST HISTORY OF SCOLIOSIS. 
The past history of scoliosis shows that from the earliest 
times, it has been a recognized condition, though only within 
the last hundred years or so has it been separated from 
deforming disease of the spine. As early as 400 b.c. Ilippoc- 182 
SCOLIOSIS 
rates classified curvatures and advocated methods of 
treatment, thereby showing certain principles which are 
still the foundations of correction, though the methods of 
his time were much more crude. 
The work of Dr. Pare in the sixteenth century is of interest. 
He then asserted that “faulty garments” and “undecent 
postures” were causes of lateral curvature. He also recom- 
mended treatment in this manner: “The remedy for this 
deformity is to have breast plates of iron, full of holes all 
over, whereby they may be lighter to wear, and they must 
be so lined with bombaste that they hurt no part of the 
body. Every three months new plates must be made. 
But these plates will do them small good that are already 
at full growth.” The work at that time was put into the 
hands of skilled armorers.1 
EXERCISES FOR CORRECTION OF LATERAL 
DEVIATIONS OF THE SPINE. 
For the correction of both postural and structural lateral 
curvature of the spine, the type and arrangement of exercises 
in the program will be similar to that used for the correction 
of the antero-posterior faulty postures. The aims are, as 
in those cases, to increase flexibility, to strengthen muscles 
in order to hold the corrected position, and to train the new 
neuro-muscular coordinations. 
It will be found that in the correction of lateral deviations, 
correction of the antero-posterior posture is usually the 
major part of the problem, since in both postural and 
structural lateral curvature there is generally an accom- 
panying faulty posture of this type. 
1 Bigg, Heather: An Essay on General Principles of the Treatment of 
Spinal Curvature. LATERAL DEVIATIONS OF THE SPINE 
183 
Plan of the Exercise Program. 
1. Introductory: 
Exercise to induce deep breathing. 
Relaxation exercise. 
Posture training. 
2. Exercises for general flexibility. 
3. Exercises for local flexibility. (Lateral and antero- 
posterior.) 
4. Self-correction. (Assisted by teacher at first. Also 
to be done before mirror.) 
5. Exercise for strengthening back, in the corrected 
position. 
6. Abdominal exercise. 
7. Relaxation. (Hook-lying position.) 
8. General exercise for strengthening muscles in corrected 
position. 
9. Posture training. 
10. Practice balance exercises of various sorts. Also 
walking in good posture. 
Relaxation—lying. 
At the conclusion of every lesson the pupil should be 
asked to assume, by his own effort, the utmost correction 
and best posture possible. The mental impression of the 
end and aim of the lesson is then much more definite. At 
the same time admonitions as to the importance of fre- 
quent effort at home should be given by the teacher. 
A large part of the program should be devoted to training 
the sense of the correct position and to strengthening muscles 
by symmetrical exercises to hold the position. The exercises 
indicated in Chapter VII will be found available for this 
purpose. 
As symmetrical are now used more generally than asym- 184 
SCOLIOSIS 
metrical exercises in the correction of lateral deviations of 
the spine, only a few of the simpler and more useful of the 
latter will be described here. These are for the purpose of 
increasing lateral flexibility. It is a difficult matter to 
localize asymmetrical exercises, especially in the case of a 
compound structural scoliosis, so that correction of one 
curve may not produce exaggeration of the other. It is 
not desirable to increase flexibility to too great a degree, 
as it may act as a factor for evil rather than good. Unless 
the back can be held in the corrected position made possible 
by increased flexibility, this very flexibility will allow the 
spine to sag out of position still farther and to succumb 
to the influence of outside forces. Exercises should be 
worked out carefully, and rigidly supervised, otherwise 
they are not only useless but may be harmful. 
Exercises in suspension are given to a considerable extent 
because traction on the spine by the body weight tends to 
straighten it. 
Exercises for Increasing Flexibility. (All 
Excepting 1 and 2 are Asymmetrical.) 
1. Passive hanging from horizontal bar. (See Fig. 33, 
Chapter VII.) 
2. Head suspension by use of the “Sayre” head sling. (For 
structural curves.) 
Note.—This should always be supervised (Fig. 78). 
3. Side falling at rings (Figs. 79 and 80). 
Position.—Grasp rings. Elbows slightly bent. Feet 
on floor. 
Movement.—Trunk bent to side of existing convexity. 
(As illustrated, trunk bending to left, for correction 
of a left total curve.) LATERAL DEVIATIONS OF THE SPINE 
185 
Fig. 78.—Sayre head-suspension apparatus. 
Fig. 79.—Total curve, 
Fig. 80.—Side falling. 186 
SCOLIOSIS 
4. Standing. “Keynote position,” asymmetrical arm exten- 
sion (Fig. 81). 
Position.—Hands at shoulders; elbows at sides of body. 
Fig. 81.'—Correcting a convexity to the right, with low left shoulder. 
Movement.— Arms extended slowly; the arm on the 
side of the low shoulder is extended upward, the 
other arm sidewrays. This may be varied to meet 
requirements sometimes encountered by extending 
arms in other combinations of positions. Trial LATERAL DEVIATIONS OF THE SPINE 
187 
must be made with each individual until the best 
correction is obtained. 
5. Sitting. Side bending (Fig. 83). 
Position.—Sitting. Hand at neck (low shoulder). 
Other hand on convexity of curve. 
Fig. 82.—A left total curve to 
be corrected by exercises. 
Fig. 83.—Side bending of trunk. 
Movernent.—Bend to side of convexity, exerting pressure 
with hand, 10 times. This exercise may be per- 
formed also in the standing position. Another 
variation is to stand with the convexity of the curve 
against a horizontal bar. Bend to side, over the 
apparatus, allowing the arm on that side to hang 
free, with other hand at neck. This gives more 
forcible correction. 
6. Pushing dumb-bell upward (Fig. 84). 188 
SCOLIOSIS 
Position.—Sitting. One hand on hip; one hand at 
shoulder, holding dumb-bell (2 to 4 pounds). 
Movement.—Extend arm slowly upward (on side of con- 
cavity). Return to shoulder without relaxing the 
muscles of the back. Repeat as long as good position 
can be held. 
Fig. 84.—Slow arm extension upward with heavy dumb-bell. 
7. “Spring sitting” position. May be used for the correction 
of either postural or compound structural conditions. 
Must be adjusted carefully to individual needs. 
Position.—Sitting on edge of stool. Forward leg bent 
at right angle. TYPICAL PROGRAMS OF EXERCISES FOR SCOLIOSIS 
189 
Movement.— Other leg extended backward; one arm 
extended upward; one arm extended downward or 
sideways. Hold position a few seconds; relax; 
return to first position and repeat 5 to 10 times 
(Fig. 85). 
Fig. 85.—Spring sitting position. 
8. Standing. Forward fall out. A variation of the pre- 
ceding exercise. 
Movement.—Forward knee bent at right angles. Other 
leg extended backward. Trunk inclined in line with 
backward leg. Arms extended to keynote position. 
TYPICAL PROGRAMS OF EXERCISES FOR SCOLIOSIS. 
(Subject to Modification.) 
Postural Left Total Curve. 
1. Relaxation exercises (body-freeing). 
2. Stationary running (to induce deep breathing). 190 
SCOLIOSIS 
3. Correction at mirror (with assistance). 
4. “Bicycle” (general flexibility). 
5. Trunk bending to left; sitting or at rings. 
6. Arm extension to “keynote position.” 
7. Practise self-correction. 
8. Standing in corrected position. Raise arms sideways, 
holding heavy dumb-bells (general strengthening). 
9. Lying on mat. Knee bending (abdominal). 
10. Active hanging. (Strong back exercise.) 
11. Mosher exercise. 
12. Self-correction. Walking—holding correct posture. 
Structural Right Dorsal-left Lumbar Scoliosis. 
1. Relaxation exercises (body-freeing). 
2. Jumping-jack exercise (to induce breathing). 
3. Passive hanging (flexibility) or a recumbent pressure 
exercise on apparatus or by instructor. 
4. Spring sitting (carefully worked out). 
5. ‘‘Bicycle.” 
6. Mosher exercise. 
7. Practise self-correction with aid of teacher. 
8. Lying on back. Knee circling or knee bending 
(abdominal). 
9. Arm extension to “keynote position.” 
10. Sitting; hands on head; spine stretching; or sitting 
with iron bar extended upward; pull downward slowly and 
forcibly behind shoulders. 
11. Self-correction; walking, etc. 
12. Rest in relaxed position on mat. CHAPTER Xr. 
THE FEET. 
MECHANISM OF THE NORMAL FOOT. 
Before considering some of the abnormal conditions of 
the feet, it is well to go over, briefly, the normal mechanism. 
The human foot is a structure consisting of twenty-six 
small bones joined by ligaments and muscles so adjusted as 
to give the best conditions for weight bearing and elasticity 
of gait. A great burden of responsibility rests upon them, 
for they must act as a base of support and as a means of 
locomotion. In the busy life of the present day this means 
almost constant use. 
The bones of the foot are arranged in three groups: 
1. Bones of the tarsus or tarsal bones. These are os 
calcis, or calcaneum (the large bone of the heel). Astragalus, 
directly above the os calcis, articulates with the tibia and 
fibula to form the ankle-joint. Scaphoid, also called the 
navicular bone. Cuboid. External, middle and internal 
cuneiform. 
2. Bones of the metatarsus or metatarsal bones (five). 
3. The phalanges or bones of the toes (fourteen). 
The arrangement of these bones is such as to present two 
well-marked arches. 
ARCHES OF THE FOOT. 
The longitudinal arch extends from the heel forward to 
the ball of the foot, and is called, commonly, the “instep.” 192 
THE FEET 
The transverse, or anterior arch, formed by the heads of the 
metatarsals, is at right angles to the longitudinal arch just 
back of the toes. 
The longitudinal arch is supported by strong ligaments 
on the under or plantar surface of the foot. Two of these, 
the calcaneo-cuboid (called by Gray the long and short 
plantar ligaments), are, next to the ligamentum patellae, the 
strongest in the body. These bind the os calcis to the cuboid 
and to the last three metatarsals on the outer side, so that 
this part of the foot is held firmly and acts almost as one 
piece, while the inner side is more free and most of the 
Fig. 86.—Antero-posterior arch: 1, short plantar ligament; 2, long plantar 
ligament; 3, plantar fascia. (R. Tait McKenzie.) 
support is muscular (Fig. 86). The arched contour is 
preserved not alone by these ligaments and the plantar 
fascia, but by the action of several muscles. These are the 
short muscles on the sole of the foot, aided by muscles con- 
necting the foot with the tibia—notably the tibialis anticus 
and tibialis posticus. 
SHAPE OF THE FOOT. 
The shape of the normal foot is triangular, with the apex 
of the triangle toward the heel and the broad part forward SHAPE OF THE FOOT 
193 
at the toes. The weight of the body is borne upon three 
points: the heel, base of the big toe and base of the little toe. 
In savages and infants the foot is almost fan-shaped and 
has a wide range of movement, also considerable prehensile 
power. Savages use the straight foot position, and the 
manner of walking in the case of races which are unhampered 
by shoes is by strong flexion of the anterior part of the 
foot, almost digging the toes into the ground at each step, 
propelling the weight of the body forward by a strong push 
with the great toe. 
Fig. 87.—Primitive foot unhampered by shoes. Note fan-shape. 
Between these unshod races and civilized man there is, 
in most instances, a great difference in the shape and use of 
the foot. In conformity to the decrees of fashion, this is 
brought about by wearing shoes improperly shaped which 
crowd the toes together and press the big toe into such a 
position that it can no longer functionate to advantage. 
The result is not only a deformed foot, but one that has lost 
much of its elasticity and capacity for comfortable use. 194 
THE FEET 
STRAIGHT POSITION OF THE FOOT. 
The position of the foot in standing and walking has an 
important bearing upon its strength and usefulness. It is 
Fig. 88. —A, strong position, feet straight; B, weak position, feet turned out. STRAIGHT POSITION OF THE FOOT 
195 
now generally admitted that keeping the “toes turned out” 
which has been taught to the young for generations, should 
not be encouraged, as it is one of weakness. The position 
of the feet with the toes pointing straight ahead is more 
natural and stronger. 
An analysis of the mechanics of walking shows that the 
weight of the body as it is carried forward, in order to be 
transmitted in the most economic manner, must pass through 
the center of the hip-, knee- and ankle-joints and the long 
axes of the femur and tibia of the advanced foot. This is 
done by extension of the hip and knee of the posterior leg, 
the body weight being lifted by strong extension of the ankle, 
carried through the long diameter of the foot to the big toe 
and by means of its leverage, the body is propelled onward. 
If the position of the foot is pointed straight ahead, then the 
weight falls along the whole length of the arch, with the 
advantage of the leverage of the big toe. With the toes 
turned out, the weight falls upon the foot at an angle striking 
a point at about the middle of the longitudinal arch, the 
anterior part of the foot takes little part in weight bearing 
and the leverage of the big toe is lost. Strain is apt to result, 
or at least, there is not the most economic use of the foot as 
it is working at a mechanical disadvantage. This position 
also tends to shorten the tendon of Achilles, still further 
weakening the foot. If the foot weakens under the strain 
of this position there will be a tendency for it to turn out 
still more, and so a “vicious circle” has been established (Fig. 
88). 
This theory is borne out by the instinctive tendency mani- 
fested when there is insecurity of one’s stance. For example, 
if the feet are slipping on an icy pavement, the natural 
reaction is to turn them in, and to endeavor to grip the 
ground with the toes. Other instances may be found in 196 
THE FEET 
certain wrorks of art in which the painter or sculptor wishes 
to give an impression of strength. This is clearly shown 
by the statue of Farragut, standing on the deck of his ship 
(Fig. 89). Another advantage of the straight foot position 
is that progress can be made faster. 
Fig. 89.—St. Gauden’s statue of “Farragut,” showing strong position of 
the feet and strong erect posture. 
ABNORMAL CONDITIONS OF THE FEET. 
In studying abnormal conditions in which the longitudinal 
arch is concerned we find three types—the weak foot, the ABNORMAL CONDITIONS OF THE FEET 
197 
strained foot and the flat foot, sometimes designated as the 
“fallen arch.” 
The Weak Foot.—This might be called a postural defect 
of the foot, a condition of relaxation of the muscles that 
allows a slight displacement downward of the bones. It will 
probably appear to be a normal foot when not bearing weight. 
Such a foot becomes easily fatigued and may be swollen, 
though there may be little or no pain present. On examina- 
tion it will show a slight tendency to roll toward the inner 
side when the weight is placed upon it (pronation), but if 
measures are promptly taken in adjustment of shoes and 
in performing simple exercises, the trouble will go no further 
and normal conditions may be restored easily. Many 
children show a tendency to weak feet. It accompanies a 
condition of general muscular weakness and is frequently a 
concomitant of faulty postures. 
If allowed to persist weak feet soon pass to the next stage 
and become strained. 
The Strained Foot.—As the foot becomes increasingly 
weaker, it is less able to meet the demands of the person’s 
activities and the muscles relax further. The strain then 
falls upon the ligaments, inward rolling becomes more pro- 
nounced and some pain will probably be manifested. 
The Flat Foot.—The final stage of a progressively weak 
foot is the typical flat foot, or “fallen arch.” In this stage 
the muscles and ligaments no longer hold the bones in their 
correct relation becoming relaxed and strained until often 
no semblance of an arch remains (Fig. 90). Pressure then 
falls upon nerves and bloodvessels and a painful condition 
results. The foot becomes increasingly stiff until nearly 
all elasticity and flexibility in the foot and ankle joints are 
lost. Walking becomes awkward with, perhaps, little 
motion in any of the joints excepting the hips. The char- 198 
THE FEET 
acteristic gait accompanying this condition has been pic- 
turesquely described as the “pedestal walk.” Undue strain 
is thus brought upon other muscles, with accompanying 
nerve irritation, so that pain is frequently distributed to 
remote regions, as for example to the hips, knees or back. 
Not infrequently pain supposedly of rheumatic origin 
may be traced to flat feet. 
Fig. 90.—A flat-foot. 
In extreme cases the following conditions will be present: 
1. Pronation of the foot (a combination of eversion and 
abduction). 
2. Prominence of inner border (scaphoid projects). 
3. Stiffness of foot and ankle. 
4. Short tendo Achillis. 
5. Abduction of great toe. 
Such a foot tires easily, there is a tendency to avoid loco- 
motion, and considerable pain is present, which is usually 
more noticeable when first getting up in the morning. This 
is caused by putting the weight on the weakened structures, 
which, having been relieved of their burden during the night’s 
rest, suffer anew when again subjected to strain. ETIOLOGY 
199 
There is a type of 'painless fiat foot to which attention 
should be called. This seems to be a normal condition with 
some people, notably negroes. There are no perceptible 
arches, and the entire sole of the foot is in contact with the 
ground. Such a foot may be strong but will never have 
the elasticity or grace of the other type. 
The height of the arch in a normal foot varies with indi- 
viduals and is not always an indication of the strength of 
the foot. A normally low arch may be stronger than one 
normally high and a teacher should learn to discriminate 
between an arch normally low and one which is relaxed or 
falling. The infant’s foot often shows no arch. This is due 
to a thick pad of fat on the sole, and is also because the mus- 
cles have not been used in walking. 
ETIOLOGY. 
In discussing the shape of the foot the effect of civili- 
zation has been noted, and it may be stated here that the 
causes of weak, strained and flat feet are found as the out- 
growth of civilization to a large extent. The demands of 
modern life, improper shoes, the necessity for walking and 
standing on hard pavements, each may be a contributory 
factor. 
We are told that weak or flat feet is another one of the 
penalties of the upright posture. Quadrupeds are supported 
on four extremities in the horizontal position, using all four 
feet in their activities, while man supports his body in much 
less stable equilibrium on two feet and is still further ham- 
pered with shoes which frequently cramp them and interfere 
with their normal functions. 
The disproportion between the strength of the structures 
and the strain to which they are subjected is doubtless the 200 
THE FEET 
primary cause of fiat foot. It is of frequent occurrence in 
people who are on their feet a great deal. Nurses suffer 
from this, as their duties necessitate standing for long periods 
on the hard floors of hospitals. Policemen are likewise 
noticeably troubled and many of them show the character- 
istic gait. This fact has been recognized by the city officials 
of New York, and excellent pamphlets have been issued to 
all members of the police force, calling attention to pre- 
ventive and corrective measures and giving advice in regard 
to shoes. At headquarters, exercises are given daily in 
connection with the setting-up drill and the men are encour- 
aged to seek advice and help. 
Increase of weight is another cause. This is apt to occur 
as a person grows heavier toward middle age, and there 
is less elasticity in the tissues. The extra burden is too 
great and the structures give way. An acutely strained or 
flattened foot may result from throwing the weight suddenly 
upon the foot, as sometimes happens in the gymnasium 
when landing too heavily from a jump. 
In order to account for the noticeable prevalence of weak 
feet in children, a theory has been advanced that some of 
the play activities of city children on hard pavements may 
be in a measure responsible—much jumping—the use of the 
roller skate, which allows the foot to roll inward, etc. These 
conditions and likewise the sort of shoes worn by children 
ought to be investigated as to their influence upon feet in 
their plastic growing state. 
Summary of Contributory Causes. 
1. General muscular weakness. 
2. Mechanical disadvantages of weak position of the foot 
in walking. 
3. Overweight. 
4. Faulty shoes. 
5. Acute strain. ETIOLOGY 
201 
Examination.—The pupil stands with feet bare, weight 
equally on both, and the legs exposed just above the knees, 
so that the relation to the feet may be observed. Examine 
from the front, noting any tendency to pronation. From 
the rear this may be seen readily by the alteration in the 
line of the tendo Achillis, which instead of making a straight 
line down the center of the heel curves outward (Fig. 91). 
Fig. 91.—Showing one of the first signs of flat foot. The outward deflec- 
tion of the lower end of the tendo Achillis when weight is put on the foot. 
(E. H. Ochsner.) 
The pupil is asked to walk a short distance and the position 
and action of the feet are noted. Painful and fatigue symp- 
toms should be investigated. Then, with the pupil sitting, 
the teacher manipulates the foot to ascertain whether the 
flexibility is normal, testing especially the ability to adduct 
and invert the foot. The length of the tendo Achillis is 
tested by forcible flexion of the ankle with knee extended. 202 
THE FEET 
This tendon is noticeably short in many cases, and, by 
limiting the flexion of the ankle, becomes a factor in weaken- 
Fig. 92.—Imprint of a normal foot. 
ing the foot. Normal flexion of the ankle should be to 
about 10 degrees beyond a right angle. If in walking, 
there is restriction of this action, the length of the stride 203 
RECORDING 
will be limited. In order to increase this, there will be a 
tendency for the foot to bend at the mediotarsal joints to 
turn outward and finally to pronate. 
Fig. 93.—Imprint of a flat-foot. 
RECORDING. 
An imprint of the foot is usually taken, although all 
records of this sort have a limited diagnostic value. This 204 
THE FEET 
may be done in several ways, but it is sufficient here to 
notice only the following: 
One method is to paint the sole of the foot with a solution 
of iron, a formula for which is 55 per cent tincture of chloride 
of iron; 40 per cent alcohol; 5 per cent glycerin. The pupil 
then stands upon a sheet of heavy cardboard, to which the 
impression is transferred. A more satisfactory method, which 
has the advantages of quickness and cleanliness, is by the use 
of a piece of apparatus, the ‘‘Pedograph” machine.1 This 
is made in the form of a small flat box, the top covered with 
a thin sheet of rubber which runs over an inked roller. 
Under this rubber a sheet of paper is inserted, upon which 
a print of the foot is made by having the person stand on 
the machine, bearing the weight of the body on the foot for 
a moment (Figs. 92 and 93). It is interesting, as an object 
lesson, to superimpose an outline drawing of the shoe over 
a print of the foot, and often impresses an individual when 
asked to draw conclusions (Figs. 97 and 103). 
TREATMENT. 
The treatment, depending upon the condition, is carried 
out by the following methods: 
1. Adjustment of shoes. 
2. Massage. 
3. Exercises. 
4. Support of the foot by artificial means. 
Massage.—Massage is useful when a painful condition is 
present or where there is swelling and congestion. It is 
applied not alone to the foot but to the lower leg also for 
improvement of the circulation. 
1 Made by Scholl Mfg. Co., New York. TREATMENT 
205 
Exercises.—Passive exercises should accompany or follow 
massage and as the foot improves, active exercises should 
be substituted. If a foot is stiff, considerable passive manip- 
ulation would be advisable in order to limber up the entire 
structure. Active exercises are of value in toning up the 
muscles and restoring normal posture and function. These 
exercises should be few and simple, but persisted in faith- 
fully. 
The straight position of the foot in walking and standing 
should be stressed as a factor in the treatment. However, 
it is not always advisable to give exercises as the routine 
treatment. A painful foot, or one that is weak from tired 
muscles, may need complete rest. In this situation, mas- 
sage, warm foot baths, correctly fitted shoes and rest would 
be indicated. Here, as elsew'here, there should be no hard 
and fast rules in the application of individual exercises. 
Discernment and discretion on the part of the teacher are 
essential. 
‘‘Arch Supports,” or Plates.—These are of various sorts and 
of relative value. They should be used as an adjunct to 
other treatment and worn at times when the foot is liable 
to be under extra strain. For the relief of an acute con- 
dition it is advisable to use them temporarily. The objective 
in every case should be to improve the strength of the foot 
by exercise so as to depend upon the support less and less 
until it can be dispensed with altogether. 
The types of supports or plates are too numerous to be 
described in detail, although two may be mentioned: 
One sort is made on the principle of correction of the 
position of pronation by holding the os calcis firmly, and by 
preventing its rolling, to stabilize the position of the entire 
foot. 
Another kind has flanges so arranged on either side that 206 
THE FEET 
they make uncomfortable pressure if the foot is not held in 
the position of inversion and adduction. 
All supports are cumbersome, but if worn, should be made 
from a cast of the foot, under the supervision of a specialist. 
Those sold in stores and advised by shoemakers should be 
distrusted. Any support should be only high enough to 
hold the arched position of the foot without giving pressure 
to any extent, the object being to prevent the sagging of 
the foot when the weight is borne upon it and not to force 
the arch upward abnormally. 
In the treatment of severe flat-foot it may be necessary 
to advise the use of a support constantly, at first, to relieve 
the strain and painful symptoms. 
Sometimes it is beneficial, especially with children, to 
raise the inner border of the shoes, thus throwing the weight 
on the outer borders in order to counteract the tendency of 
the feet to roll inward into a position of pronation. This is 
accomplished by inserting a lift along the inner margin of 
the sole, also raising the heel on the inside and projecting 
it forward slightly. This is called the “Thomas heel.” 
ANTERIOR METATARSALGIA. 
The so-called anterior arch of the foot passing trans- 
versely across at the forward ends of the metatarsals gives 
a slight concavity to that part of the sole of the foot. This 
arch frequently becomes flattened. As a result the heads 
of the metatarsals come heavily in contact with the ground 
at each step, a certain amount of elasticity is lost and calluses 
are liable to be formed on the sole of the foot. In the 
altered position the bones are not held firmly and are apt 
to slip and exert pressure on the nerves. This condition ANTERIOR METATARSALGIA 
207 
is known as anterior metatarsalgia, or “Morton’s toe.” It 
is characterized by acute pain localized under the heads of 
one or more of the metatarsals (usually the fourth) which 
radiates to the entire foot. The pain is usually sudden in 
its onset, and may be of such severity that relief cannot be 
gained until the shoe has been removed and the foot manip- 
ulated, so that the bones are adjusted and pressure on the 
nerves released. 
Causes.—Poorly shaped shoes, especially those too short, 
or those with pointed toes and high heels, are the chief 
cause of anterior metatarsalgia. The high heel throws the 
weight of the body forward upon the anterior part of the 
foot, pressing it downward. The foot is forced forward into 
the pointed toe, where the ends of the toes are cramped 
together and held in such a manner that spreading and 
flattening of the anterior arch is still further aggravated. 
Prolonged standing, especially in such a type of shoe, is a 
contributory cause. This condition may also originate by 
landing heavily on the forward part of the foot, if there is 
not the proper lightness and spring in the body. A 'position 
to be avoided, in which women sit frequently, which is strikingly 
pernicious in its effect upon the anterior arch, is illustrated 
in Fig. 94, p. 208. The feet are braced on the floor, bent in 
such a way that there is a strong downward pressure which 
flattens the anterior arch, and the ankle is forcibly extended, 
shortening the tendo Achillis. This position is usually 
accompanied by a poor sitting posture. As is the case in 
the relaxation of the longitudinal arch, the causes in general 
may be said to be the disproportion between the amount of 
work to be done, the strength of the structures and the 
mechanical disadvantages owing to shoes. 
Anterior metatarsalgia occurs more frequently in women 
than in men. 208 
THE FEET 
Treatment.—Suitable shoes should be the first considera- 
tion. The proper type is one which is fairly snug across the 
Fig. 94.—Faulty position of feet; straining the anterior arch; shortening the 
tendo Achillis. 
Fig. 95.—Method of adjusting pad and bandage for relief of anterior 
metatarsalgia. 
region of the anterior arch but wide at the toes. Sometimes 
a support may be necessary. This should be made with a HALLUX VALGUS 
209 
prominence which will exert an upward pressure under the 
metatarsal affected. A pad of felt about an inch in diameter 
and a quarter to a half an inch in thickness can be adjusted 
to give relief. The pad is placed on the sole of the foot 
posterior to the painful spot and is held in position by a strip 
of adhesive plaster bound snugly around the foot over the 
metatarso-phalangeal joints, preventing the spreading of the 
foot in this region. Or it may be permanently attached to 
a leather insole which can be slipped into the shoe (Fig. 95). 
HALLUX VALGUS. 
The outward manifestation of this condition is the enlarged 
joint of the great toe which has become abducted. It is 
caused by shoes—either those too short or with toes narrow 
and pointed. A hallux valgus is not curable except by 
operation. The deformity may be somewhat improved by 
wearing shoes with straight inner borders and low heels. 
There must be no pressure which might tend to force the 
great toe outward. 
A bunion is the result of inflammation of the synovial 
bursa of the joint and is accompanied by swelling, pain and 
extreme tenderness. It is usually the accompaniment of a 
hallux valgus. 
The treatment of this condition is to allay the inflamma- 
tion, remove pressure by adjustment of shoes and the 
arrangement of a pad to fit around the swelling to protect 
the sensitive area from pressure and injury. CHAPTER XII. 
SHOES-EXERCISES FOR THE FEET. 
SHOES. 
In medical and physical education circles, also among 
those interested in problems of hygiene, and even with the 
laity, there is probably no subject more frequently discussed 
than that of shoes. It cannot be too positively asserted 
that the subject is one which demands serious thought, 
for no article of dress may exert so pernicious an influence 
upon the whole bodily mechanism as improper shoes— 
especially women’s shoes. Intended originally to cover the 
feet and protect them from injury, they have, in many 
instances, become not alone deforming casings, but even 
instruments of torture. 
The essential features of a good shoe and the results 
consequent upon wearing a poorly shaped one are there- 
fore matters for earnest consideration. One authority 
describes a proper shoe as “one which supports the foot 
in its normal position when at rest, and allows the normal 
motions to take place during activity.” 
The endeavor should be to get a shoe as nearly as possible 
the shape of the foot and which therefore fits it, rather than 
a shoe, which, perhaps, appeals more strongly to the eye, 
but to which the foot has to be adjusted by crowding and 
pressure in various directions. Through false standards of 
beauty and slavery to fashion, we often fit our eyes instead 
of our feet: There is, however, no reason why a shoe” 
must necessarily be ugly in appearance. SHOES 
211 
Such a stigma, long attached to shoes known as “com- 
mon sense” and “orthopaedic,” has prevented their universal 
adoption. Many of them were awkward, heavy and need- 
lessly clumsy. In many instances also they were much 
more expensive than other types of shoes. Incidentally 
let us admit that it is an error to he too extreme in any 
direction. Sensible shoes on modified lines are now made, 
and being more sightly in appearance, will tend to increase 
a popular demand. We should not be satisfied with a 
“good” shoe at the expense of appearance, but obtain a 
good shoe plus a good appearance. 
It is not possible to recommend arbitrarily any one make 
of shoe as the best. While there are on the market many 
shoes of various makes which adhere to certain fundamental 
principles, still there are such individual differences in feet 
that no one type of shoe will fit all. These differences are 
evidenced by the results of research on the part of the 
American Posture League, showing that normal feet are of 
three distinct shapes as to their “ground plan:” lnflared, 
outflared and straight. 
The American Posture League describes them thus: 
“These three types have no relation to whether or not the 
toes are turned inward, outward or straight ahead in stand- 
ing and walking, or to whether or not the toes are bent from 
wearing shoes with ‘pointed toes.’ The type of foot may be 
understood by noting the relation of the broadest part of 
the foot to the center line of the heel carried forward, as 
shown in the illustration (Fig. 96). 
“ lnflared.—If across the ball more of the foot surface lies 
inside of the line than outside, it is an inflared foot. 
“Outflared.—\i at the ball of the foot, more of the surface 
lies outside of the line than inside, it is an outflared foot. 212 
SHOES—EXERCISES FOR THE FEET 
“ Straight.—If at the ball of the foot, the surface lies 
equally on either side of the line, it is a straight foot.” 
Shoes fitting these types of feet would necessarily differ, 
for example, an inflared shoe, on an outflared foot would 
give uncomfortable pressure on the outer border and would 
cramp the little toe. 
The natural foot, as has been stated, is broader at the 
toes than at the heel. Each one of the feet is triangular 
Inflared. Outflared. Straight. 
Fig. 96.—From illustration pamphlet published by American Posture 
League. 
in shape, both together forming a substantial base of sup- 
port for the body. The shape of the base given by the 
ordinary shoe is quite different and much less stable than 
that provided by Nature. 
The requisites of a good shoe may be stated as follows: 
1. Good appearance. 
2. Straight inner border. 
3. Wide shank. 
4. Roomy upper. SHOES 
213 
5. Heel medium low and broad. 
6. Toe not pointed. 
7. Light in weight. 
The advantage of the flexible over the stiff shank has been 
much discussed. Its value is obvious from the fact that it 
allows flexion of the foot at each step so that thus the strength 
of the muscles is maintained and the arch preserved. A stiff 
shank acts more or less as a brace and the muscles are not 
as active. The flexible shank, however, should not be arbi- 
trarily advocated as the stiff shank may be advisable under 
certain conditions. In case a person is obliged to stand a 
great deal, the stiff shank will give the feet support and keep 
the arch from sagging, especially so, if the feet show some 
degree of weakness. 
The fulness of the “upper” is an important feature of the 
shoe, as a tight upper binds down the toes, tends to depression 
of the arches and restricts motion. A tight seam over the 
top of the foot is likewise injurious in its effects, as it presses 
down the anterior arch. 
A low cut shoe is preferable to a high one as it allows free 
action of the muscles and better action of the joints of the 
foot and ankle. If a high shoe is worn, it should be laced 
rather than buttoned, as the former allows better adjustment. 
Stockings should be neither too short or too tight but well 
fitted and sufficiently elastic to conform to the shape of the 
foot. Otherwise they will act almost as a bandage, tending 
to constrict and hold the foot in a cramped position. The 
importance of well-fitted stockings in relation to their effect 
on the feet is not sufficiently appreciated. Some shoe 
manufacturers are now making right and left stockings, 
which give much more room than the ordinary type. It 
is interesting to note the Japanese stocking with its separate 
section for the great toe. Such a division is necessary to 214 
SHOES—EXERCISES FOR THE FEET 
accommodate the sandal-strap, and also places the first 
toe in a position to work to the best advantage in walking. 
A straight position of the foot is thus insured. 
Children’s Shoes.—Efforts at reform should be directed not 
only to the shoes of adults, but especially to those of children. 
Many shoes for the young have soles which are flat and stiff, 
with tight uppers which compress the feet, and hamper 
free action. Parents should understand the importance 
of procuring a shoe which is flexible, roomy and long enough 
to allow freedom of action for the growing foot of the 
child. With shoes for girls, the tendency is to begin early to 
raise the heels and point the toes. As this change is made dur- 
ing the period of growth while the bones are soft and pliable, 
the effect is most pernicious. It is not unusual to find girls 
during their adolescence with feet already deformed. The 
force of example is potent here. Girls of this age are sus- 
ceptible to suggestion and see in the clothing and shoes of 
“grown-ups” desirable standards for imitation. 
Results of Wearing an Ill-shaped Shoe.—A poorly fitting 
shoe, or one not adapted to the shape of the foot, produces 
local pain and discomfort as first results, and the unequal 
pressure also causes corns, calluses and bunions. The 
reaction upon the nervous system is considerable, and irrita- 
bility and other mal-mental states, as well as fatigue, may 
often be traced to the shoes (Fig. 97). 
The High Heels and Pointed Toes, which are characteristics 
of many of the fashionable shoes worn by women, are respon- 
sible for many evils. As the feet form the base of support 
for the body, it is essential that this base be a firm and com- 
fortable one, otherwise the superimposed structure will suffer. 
If the bearing surface of the sole of the shoe is made smaller 
by narrowing the toe and diminishing the diameter of the 
heel, the support becomes less secure and it is impossible SHOES 
215 
that there should be as great activity or endurance (Fig. 98). 
By raising the heel, the foot is tilted, crowded forward into 
the toe of the shoe, the normal motions are lost, the foot is 
Fig. 97.—The owner of this shoe and foot is a heavy woman, weighing 
nearly 200 pounds. Her feet are swollen, strained, have painful corns, 
calluses and bunions. She has chronic backache and exhibits extreme 
nervous irritability. 
used stiffly, and the whole manner of walking is altered. 
Progression is made by flexion in the hip and knee-joints, 
these usually being held in a position of partial flexion, and 
there is diminished action in the foot and ankle-joints. 216 
SHOES—EXERCISES FOR THE FEET 
If a foot is held constantly in the position explained above, 
other adjustments follow. One of the most unfortunate 
of these is shortening of the tendo Achillis, the tendon of 
the great calf muscles (gastrocnemius and soleus), known 
also as the “heel cord.” This restricts the motions of the 
foot in such a way that it may become a strong factor in 
the production or aggravation of a weak foot. It is often 
asserted that a low heel cannot be worn because the individual 
has a high arch. This is a fallacy unless the foot has become 
adjusted to a high heel. The so-called “high arch” is fre- 
quently the result of a short tendo Achillis which draws 
the ankle into a position of extension. The appearance 
of a high arch is given, when quite the reverse may be found 
if the foot is put in a natural horizontal position with heel 
and toe on the same level (Figs. 98 and 99). 
The reason why women frequently assert that they cannot 
wear low heels is because the feet have become adjusted to 
high heels and when placed in an entirely new situation in 
regard to weight-bearing and activity, muscles and ligaments 
become strained and uncomfortable. It is inadvisable that 
any radical change should be too quickly made in the type 
of shoe. For instance, the substitution of a low heel for a 
high one, unless done gradually, would probably produce 
most uncomfortable if not painful conditions. 
If the feet are normal, there is no reason why an occasional 
adjustment to higher heels and more pointed toes than are 
worn ordinarily would not be permissible and no harm result, 
but for the business of life, shoes which allow free movements 
of the feet and give a broad base should be urged. 
Another factor which cannot be ignored is the almost 
constant danger from accident. Statistics show that in one 
year more than four thousand women in the United States 
were injured because of high heels. SHOES 
217 
Wearing shoes of the kind here under consideration would 
be bad enough if the injury were confined to the feet them- 
selves, but the ill effects only begin with the feet; the adjust- 
Fig. 98.—Position of foot in shoe with high heel and pointed toe. Short 
tendo Achillis, apparent “high arch” weight thrown on front of foot. 
Fig. 99.—Position of foot in shoe with low heel. Tendo Achillis normal 
length. Arch the same, weight borne on whole foot. 218 
SHOES—EXERCISES FOR THE FEET 
ment of the whole body is disturbed by the change of posi- 
tion of the base of support; the knees and hips are thrown 
out of alignment, causing a change in the position of the 
pelvis, increasing the angle of inclination. As a result there 
are frequently displacements of the pelvic organs, muscle 
strain producing weak and painful backs, derangements of 
the nerves, and chronic fatigue. Poor postures of all sorts, 
flat chests, visceroptosis, and even lateral curvatures of the 
spine may likewise be traceable to this source. 
Summary.—The effects of wearing shoes with high heels 
and pointed toes may be manifested in the following ways: 
1. Discomfort: Corns, bunions, etc. 
2. Weak and flat feet. 
3. Accident. 
4. Decrease of working capacity. 
5. Derangement of the nerves. 
6. Displacement of organs. 
7. Poor postures. 
EXERCISES FOR THE FEET. 
Terms frequently used, relating to the posture of the 
feet are “ inversion,” raising the inner borders and “ eversion,” 
raising the outer borders. 
Exercises should be such as will strengthen the muscles 
which perform plantar flexion, adduction and inversion of 
the foot, and flexion of the ankle. The antagonistic muscles 
will need exercises to promote relaxation and stretching. 
In walking naturally, with the body well poised, the heel 
strikes the ground first as the leg swings forward. Almost 
simultaneously, the weight of the body is carried along the 
outer border of the foot and transferred across the forward EXERCISES FOR THE FEET 
219 
part to the base of the great toe, by which it is propelled 
onward. 
If the body is well poised and the chest elevated there 
will be continuity of motion, ease of carriage and elasticity 
of gait. On the contrary if one walks with the weight of 
the body over the heels, as is the case in poor posture, this 
continuity of motion is lost. A muscular effort must be 
made at each step to raise the body and to carry it onward; 
walking becomes a clumsy progression, a series of lifts and 
stops; elasticity of gait is wanting, fatigue is greater and 
frequently the joints are not fully extended, the ankles, 
knees and hips remaining in partial flexion and an extremely 
ugly appearance is the result. 
1. One of the best exercises for the feet is the continual 
practice of walking with the feet slightly inverted 
and with the toes pointing straight forward. 
2. Attention should be given to the establishment of a habit 
of standing with the arches drawn up with the weight 
on the outer borders, rather than allow the weight 
to bear down passively on a relaxed foot. 
3. Exercises for correct walking, balance exercises, slow toe 
march and similar exercises are valuable both for the 
feet and for posture. 
Note.—All standing exercises should be performed with 
the feet straight and about six inches apart. 
4. Sitting. Foot circling. 
Position.—Sitting. Cross one knee over the other, so 
that the leg hangs free. 
Movement.—Extend ankle, pushing down with toes, 
then turn foot inward and upward, in a circular 
motion, flexing the ankle strongly. 
5. Sitting. Ground-gripping exercise (Fig. 101). 
Position.—Feet parallel on floor. 220 
SHOES—EXERCISES FOR THE FEET 
Movement.—Raise the arch by attempting to draw the 
toes toward the heel, turning the toes inward with 
Fig. 100.—Correct walking. Students of Central School of Hygiene and Physical Education, New York City, EXERCISES FOR THE FEET 
221 
strong inversion. The same exercise may be done 
in the standing position. 
6. Standing. Rise on toes. Then lower heels slowly with 
weight on outer sides of feet. 
7. The “Grip Walk. ” Step forward with one foot. As the 
weight is brought forward, grip strongly with ad- 
vanced foot. Relax grip as the next step is taken and 
repeat thus—“Step and grip, step and grip.” 
8. Stand on low stool or book, with edge just under the heads 
of the metatarsals. 
Movement.—Strong plantar flexion of foot. 
Fig. 101.—Ground-gripping exercise. 
9. Endeavor to pick up small articles with the toes, such as a 
pencil, piece of chalk, or marble. Also grip a dumb- 
bell. 
Note.—Numbers 8 and 9 are especially helpful for 
strengthening the anterior arch. 
All these exercises should not be given at once. Tt is more 
desirable to choose two or three and practise them faithfully. 
To be of any value they must be done persistently two or 
three times a day and as many times as possible without 
undue fatigue. 
If the individual is interested and will form the habit of 
drawing the foot into position frequently much improvement 222 
SHOES—EXERCISES FOR THE FEET 
can be made. This and the “ground-gripping” exercise can 
be performed while wearing the shoes—a distinct advantage. 
Passive Exercises.—For weak or stiff feet it is sometimes 
advisable to use passive exercises, the same for either condi- 
tion; but for the weak foot the exercises should be given 
gently, while for the stiff foot it should be done with consid- 
erable force. In connection with either condition, massage 
would be a great benefit. 
The pupil should sit facing the teacher, who holds the foot 
in her lap, or the leg may be extended on a plinth or couch. 
The teacher then grasps the ankle firmly, behind the heel. 
Fig. 102.—Exercise to stretch a short tendo Achillis. 
1. Forcible Plantar Flexion of the Foot.—Grasp the toes 
and bend downward at the metatarso-phalangeal joints. 
2. Plantar Flexion with Adduction and Inversion.— Start 
as in number 1. Bend toes downward then turn foot upward 
and inward. 
3. Flexion of Ankle with Adduction and Inversion.—Add 
to exercise number 2, a strong upward push on the sole of 
the foot, holding the heel firmly to prevent flexion of the knee. 
This is an excellent exercise for stretching the tendo Achillis. 
ACTIVE EXERCISES FOR A SHORT TENDO ACHILLIS. 
1. Walk on the heels, with the feet straight, toes raised. 
2. Stand. Let the body fall forward from the ankles until ACTIVE EXERCISES FOR A SHORT TENDO ACHILLIS 
223 
supported diagonally by the hands, which are placed at 
shoulder height on wall or other upright. 
Fig. 103.—Showing difference in size of base furnished by a broad sole and 
heel and by a narrow toe and high heel. (From actual drawings.) 224 
SHOES—EXERCISES FOR THE FEET 
3. Stand. Heel on floor, toe elevated against a block, or 
some firm support. Sway body forward until a pull is felt 
on the cord. This is performed with one foot at a time 
(Fig. 102). 
FOOT EXERCISE GAMES. 
For the purpose of arousing interest, especially with chil- 
dren, the necessary elements in foot exercises can be embodied 
in simple games. A child will work more intensively and 
longer with the game as an objective. 
1. Competitive foot race. 
Walking a stated distance on the outer borders of feet. 
2. Competitive marble game. 
Picking up marbles with toes and placing them in a 
receptacle. Each pupil is given an equal number, and 
each foot must be used the same number of times. 
3. Foot-writing. 
Grasp a piece of chalk with the toes, and with foot 
inverted with the outer border toward the floor, 
endeavor to write the name. 
4. Competitive “tit-tat-toe” game, with chalk, on the floor. 
5. Competitive game with checkers. 
Grasp checker with toes and place on board. The 
child placing all his checkers first, wins. (Checker 
boards can be purchased at the ten cent stores.) 
6. The “Foot Juggler.” 
Two pupils lie on their backs on the floor. The legs are 
extended upward, and a large ball is held on the soles 
of feet. The ball is to be tossed and caught on the 
feet. The one keeping the ball in action longest, 
wins game. 
With the exception of number 4, these can be done alone, 
as well as in competition. CHAPTER XIII. 
INFANTILE PARALYSIS. 
Infantile paralysis is one of the most baffling and dreaded 
of the diseases of childhood. Although it also attacks adults 
occasionally, it is among children that the majority of cases 
are found, and it seems equally prevalent in all classes of 
society. 
The term anterior poliomyelitis is a more technical name 
for the disease because the chief seat of the affection is in the 
anterior columns of the spinal cord, but the term infantile 
paralysis is used much more generally by the laity. 
It occurs usually as an epidemic form of disease, which 
seems to be increasing in this country. The most recent of 
these attacks was the one which swept over the East in 1916, 
and was especially violent in and around New York City. 
For many years, research work has been carried on unceas- 
ingly in experimental laboratories. State boards of health 
have spent large sums of money for purposes of investigation, 
and in sending corps of physicians to the communities 
affected in endeavors to find their probable source or sources 
of infection. All conditions of environment have been noted, 
and suspicion has been directed toward many kinds of 
insects, animals, food, water supply, sewage, dust and so on, 
but no definite conclusion has been reached. 
Conditions pertaining to hygiene should be controlled as 
far as possible for the reason that they appear to be contribu- 
tory to this as to any other infectious disease, and they are 
also probable factors in the spread of the evil, One important 226 
INFANTILE PARALYSIS 
fact concerning it has been established: namely, that it is 
readily communicable, not only by the person having the 
disease, but also by the “ healthy carrier.’’ In a report of the 
research work of the Rockefeller Institute, the statement is 
made that “epidemic poliomyelitis has been clearly observed 
to follow the lines of human contact and travel.” 
There should be for several weeks strict isolation of a case 
and of those who have been exposed, and attendance at school 
especially, should not be allowed for some time. During the 
epidemic in New York the schools were closed and many of 
the theaters and public resorts excluded children. Quaran- 
tine measures were adopted and lines of travel to and from 
the city were carefully watched in order that the community 
might be safeguarded from possible “carriers.” 
It staggers the mind when one reads in the report of the 
New York State Department that “ approximately 9023 cases 
of poliomyelitis were reported during 1916. The mortality 
was about 25 per cent, leaving approximately 6755 cases, of 
which by far the greater number required after-care treat-: 
ment.” The aftermath in the hospitals was a pitiful sight, 
for a large proportion of those afflicted, even under the best 
possible treatment, were disabled to some degree. 
Investigations have proved that anterior poliomyelitis is an 
infectious disease, produced by a tiny virus which is tough 
and resistive to many destructive measures. Its entrance 
to the body is through the digestive and respiratory tracts, 
more frequently through the latter by way of the nose and 
throat. Then circulating in the blood stream it causes toxic 
changes which injure the nerve cells, especially those of the 
anterior horns of the spinal cord. As these cells are in the 
roots of the motor nerves that supply the muscles, stimulat- 
ing them to action, the part of the cord affected and the 
amount of destruction taking place will determine the areas TREATMENT 
227 
and extent of paralysis of the muscles. Sometimes the injury 
to the nerve cells is slight and consequently the repair may 
be complete. In such a case the individual recovers entirely. 
However, more frequently there is considerable injury, the 
repair is less and the recovery of muscular action is limited. 
It not infrequently happens that entire destruction of the 
nerve cells has taken place, influencing more extensive mus- 
cular areas, resulting in those hopeless cases of paralysis 
that can never be improved. 
The aye at which infantile paralysis is most liable to occur 
is between two and three years. Statistics show that 71 per 
cent of the cases are found in the first five years of life and 
87 per cent in the first ten. After ten years of age its occur- 
rence is less frequent. From the ages of eleven to twenty 
years it drops considerably, but even to the age of forty or 
forty-five years there may be an occasional appearance. It 
seems to attack the sexes equally, but the individual who has 
been once afflicted is immune to further attacks. 
SYMPTOMS. 
The symptoms are similar to those of any infection and 
there is nothing to distinguish its onset from any of the 
so-called “children’s diseases.” Usually there is a slight 
feverish attack. There may also be digestive disturbance 
or sore throat, or it may be thought that the child has a cold, 
and in this stage diagnosis is rarely made as the paralysis 
does not occur at once but usually at a period of from one 
to eight days. There is considerable tenderness in some cases. 
TREATMENT. 
During the acute stage of the disease the patient should 
he kept quiet in bed and care be taken to prevent if possible 228 
INFANTILE PARALYSIS 
the beginnings of deformities winch might occur from wrong 
positions in bed or even from so slight an influence as the 
pressure of the bed-clothing. 
After the acute stage has passed and all pain and tenderness 
have subsided, treatment should be commenced for the 
restoration of muscular power, and for prevention of deformity. 
The time within which it is possible to regain muscle power 
varies in different cases, but treatment should be persisted 
in for at least two years. Some recover quickly, others more 
slowly, and may never regain full power. If the respiratory 
centers have been paralyzed death ensues. 
Treatment of the prevention of deformity should be con- 
tinued during the period of the growth of the child so that 
contractions may be prevented and scoliosis avoided or 
minimized. The need of early care in the prevention of 
lateral curvature of the spine must be borne in mind. General 
muscular weakness, the unequal tone of the muscles, asym- 
metrical modes of walking, or one-sided use of the arms, tend 
to produce or exaggerate this deformity. Some of the worst 
cases of scoliosis are of paralytic origin. Deformities of the 
limbs also occur from the unantagonized pull of the muscles, 
when the opposing groups have been affected. 
Operative Treatment.—Many operations are performed 
for the improvement of function and for the establishment of 
greater stability. Tendon transplantation has been used 
extensively and in many cases with much success. It consists 
in connecting the tendon of the affected muscle with that of 
an uninjured one in such a position that the latter will 
perform the function of the muscle which has been paralyzed. 
Nerve transplantation has been used somewhat but without 
much success. Tendon lengthening and shortening are both 
of value in allowing either more or less freedom of motion to TREATMENT 
229 
joints. Arthrodesis, or the surgical fixation of a joint, is 
sometimes performed. 
Electricity.—Although electricity has been quite generally 
employed in the treatment of infantile paralysis, nevertheless 
its use is now a subject much discussed and strong arguments 
as to its lack of value have been advanced. 
Heat.—This is useful for giving artificial stimulation to 
the parts affected and in helping nutrition of the tissues by 
increasing the circulation. This form of treatment can be 
given by means of various sorts of apparatus, from the 
electric “baker” for radiant heat, in the office of the specialist, 
to the humble oven in the kitchen of the home. Hot water is 
sometimes used, or preferably hot sand, in which the part 
affected is immersed. 
Massage.—Massage is of value in stimulating the circula- 
tion and in toning up the muscles, but it has no effect what- 
ever upon the reestablishment of the neuro-muscular control. 
Care must be taken that the manipulations are not too hard 
or too long continued, as in such case the muscles will become 
overtired. 
None of the above-mentioned methods of treatment should 
be used alone, since they are of value only as they stimulate 
the circulation and improve the tone of the tissues. But 
they may be employed as useful adjuncts to the important 
feature of the treatment, viz.: 
Muscle Training.—The value of muscle training cannot be 
overestimated, as it makes necessary the effort of the 
individual to send motor impulses down unused paths, 
thereby reestablishing the lost or forgotten neuro-muscular 
control. 
It is important that the individual should be alone with 
the teacher for treatment so that attention shall not be 
diverted, for powerful concentration is necessary in order to 230 
INFANTILE PARALYSIS 
accomplish any result. The teacher must encourage and 
stimulate effort in every possible way. The part to be 
exercised should be uncovered. 
In the beginning, if excessive contractions have occurred 
in the opposing groups, it will be advisable to passively 
stretch the shortened tendons. This must be done carefully 
so that resistance will not be offered through the patient’s 
fear of being hurt. With flaccid or very weak muscles it will 
be necessary to begin with passive exercises, and during the 
performance of these the child is asked to make an effort. 
When even the slightest response comes, the exercise becomes 
assistive, the teacher guiding and helping less and less until 
the ability to perform an active movement is established. 
In some cases the work may be carried still further and 
resistive exercises given. 
Training before a mirror is excellent, especially so for the 
leg paralyses, as the individual can be trained to make the 
proper coordinations in walking by repeated observation 
of himself in the mirror. 
It is important that the exercises shall not be continued so 
long a time that the muscles become fatigued. It has 
been proved that serious harm is often done in this way. 
By too zealous effort to produce results, the weakened muscles 
have been overtired, and thus still further weakened. All 
exercises must be done slowly and carefully to the extreme 
of the movement, and they must be repeated day after day 
for a long period. Great patience and courage are needed, for 
in the majority of cases results come very slowly. 
In the regular routine of the teacher of individual gym- 
nastics the treatment of infantile paralysis in all probability 
will be confined to an occasional case. A thorough under- 
standing of anatomy and kinesiology is essential for the TREATMENT 
231 
proper application of treatment, and the teacher should work 
under the direction of an orthopaedic surgeon. 
In a book of this sort, it would be inadvisable to lay out a 
plan of exercises, and the aim of this chapter has been to 
indicate conditions only in a general way, and to recommend, 
for further enlightenment and help, the best authority on the 
subject.1 
Braces.—Braces are used in connection with the treatment: 
1. To correct deformities. 
2. To prevent development of deformities. 
3. To aid in locomotion. 
Braces should not be worn any more than necessary but 
only as an adjunct to the treatment, excepting in the more 
severe cases, where the disability or deformity is extreme. 
They should be simple and light in construction, and adjusted 
so as not to impede the circulation. They should be fitted 
under the direction of a specialist. 
1 Lovett: Treatment of Infantile Paralysis, Blakiston, Philadelphia, 
1916. CHAPTER XIV. 
CONSTIPATION-DYSMENORRHEA. 
CONSTIPATION. 
One of the functions of the body most essential for its 
well-being is the elimination of waste matter through the 
intestines. If this is not done with frequency and regularity, 
constipation results, and this condition is so prevalent that 
it clearly proves the fact that the importance of this function 
is underestimated and even ignored by many people. 
The formation of poisons in the residual matter of the 
intestines soon causes a toxic condition throughout the 
body, and is the cause of many ills. 
It is noteworthy in this connection and also most significant 
that when the advice of a physician is sought—whether it 
be for a cold, a headache, or perhaps some more serious 
illness, ailment or disease, one of the first inquiries made by 
him concerns the patient’s condition as to constipation, and 
almost invariably a cathartic is prescribed as the initial 
measure in the treatment. 
Causes.—Constipation may be the result of poor posture 
or a ptosis—both of which, as has been seen, affect the tone 
and strength of the abdominal walls and results in the sagging 
and imperfect functioning of the enclosed organs. It may 
also be due to improper diet or too small an intake of water, 
lack of exercise or to careless habits. One or all of these 
factors may participate in the causation of this troublesome 
affliction, and unless steps are taken to remove the cause, 
constipation becomes chronic. CONSTIPATION 
233 
Treatment.— Habit.—There should be a natural and com- 
plete evacuation of the bowels every day. The ideal would 
be twice a day, morning and night. This is largely a matter 
of habit and should be cultivated and rigidly adhered to at a 
regular time daily. No pressure of other duties or any excuse 
whatsoever should be allowed to interfere. Too much stress 
cannot be placed upon the importance of forming this habit. 
The vital necessity of establishing it as a part of the daily 
routine should be instilled into the minds of children at an 
early age and its regularity insisted upon. 
It is also an essential consideration that it is possible to 
have a movement of the bowels every day and yet to be con- 
stipated. In such case the evacuation is not complete, and 
the residual waste matter constitutes a veritable poison 
center to which many bodily ills may be traced. It is a wise 
measure for everyone, admitting the possibility of such a 
condition, to take a mild cathartic periodically for the pur- 
pose of thoroughly clearing the intestinal tract. For this 
some of the laxative mineral waters are excellent. 
Diet.—In the treatment of constipation diet is important. 
Some coarse food, plenty of green vegetables and fruit should 
be included in the daily menu, which may follow in a general 
way such an outline as is given herewith: 
Breakfast.—Fruit; cereal (preferably coarser varieties), 
such as oat or corn meal. The cooked 
cereals are best, although shredded wheat 
is good. Bran, either alone or with 
another cereal, is recommended. Eggs 
can be added to the breakfast and coarse 
bread with plenty of butter. 
Luncheon.—Simple salads; green vegetables or fruit; 
coarse bread and butter. 234 
CON ST IP A TION—D YSMENORRHEA 
Dinner.—Thin soup; meat or fish; two sorts of 
vegetables (spinach is appetizing and 
healthful); salad; coarse bread. Almost 
any sort of dessert desired may be added 
excepting pastry. 
Water Drinking is Important.—On arising a glass of water 
should be taken—some physicians advise cold water rather 
than hot as being more stimulating. Between breakfast and 
luncheon take two glasses, also two between luncheon and 
dinner, and one at least before retiring. A glass may be 
taken at each of the meals if desired, but not with the food. 
If not taken at meals, more should be taken between meals, 
and the quota for the day ought to be six glasses or more. 
The establishment of a habit of drinking plenty of water 
is one of the greatest of the aids to health. 
Massage is useful in the treatment of constipation, espe- 
cially in chronic conditions. It stimulates the peristaltic 
action and mechanically loosens any hard waste products 
in the intestines and passes them onward. The direction 
of the course of the large intestine must be followed, starting 
from the right side of the groin, up, across the abdomen, 
above the umbilicus, and down toward the rectum on the 
left side. 
Treatment by Exercise.—In no condition is exercise more 
sure in its results than in the treatment of constipation. It 
is the stimulation to “peristaltic action” that is the purpose 
of exercise. However, there must be persistent and long- 
continued effort, aided by attention to other hygienic meas- 
ures, such as have been previously indicated. 
There should be borne in mind the muscular structure 
of the organs of digestion, and also the fact that their func- 
tions are performed by the action of their muscle fibers. 
If the tone of the muscular walls of the intestines is poor, CONSTIPATION 
235 
their action will be sluggish, a condition of stasis results 
and the waste matter is not passed along and discharged 
from the body. 
The effect of exercise upon constipation is well formulated 
by Gant, who says substantially that: 
The first effect is to stimulate the processes of absorption, 
nutrition and elimination by increasing the general circula- 
tion. The second effect is to increase the peristaltic action 
of the intestines by assisting in a more speedy removal of 
the carbon dioxide. The third effect is the increase of respira- 
tion and is considered the most important. The deeper 
breathing causes the diaphragm to work more actively, 
and its descent being greater and stronger a definite massage 
is transmitted to the digestive organs. The fourth value is 
that the glands of the pancreas, liver and intestines, which 
secrete the digestive fluids are stimulated, causing them to 
pour forth their secretions more abundantly, and soften the 
waste matter in the intestines. The fifth effect is the lessening 
of auto-intoxication in the elimination of the waste matter 
from which poisons are absorbed into the blood. The im- 
provement of the general muscular strength through exercise 
is the sixth effect, and the final reason given is the improved 
action of the intestines through the stimulation of the 
nerves. 
Exercises. 
If there is a condition of poor posture or a ptosis in con- 
nection with constipation, exercises for correction should 
be given as before indicated. 
1. lie on the back; legs extended. Draw knees to chest 
alternately making considerable pressure on the abdomen, 
giving additional pressure by clasping the hands across the 
abdomen. Slowly—6 to 10 times with each leg (Fig. 104). 236 
CONSTIPATION—DYSMENORRHEA 
2. Lie on the back; legs extended; draw knees upward on 
the right side swing across abdomen, when drawn up, from 
right to left, keeping the hips as immovable as possible. 
Then extend the knees slowly, letting legs return to first 
Fig. 104.—Knee-pressure exercise for constipation. 
Fig. 105.—Forward bending exercise for constipation. 
position. Five times. (This is for stimulation of large 
intestine.) 
3. Lie on the back. Draw both knees to chest, then circle 
them together first to right, then to left side. Five times 
each side. CONSTIPATION 
237 
4. Sitting. Hands clasped over abdomen. Feet elevated. 
Bend forward as far as possible making pressure on abdomen, 
10 times or more. (Fig. 105.) 
5. Sitting. Hands on hips; trunk circling. (See Fig. 63, 
p. 140.) 
Fig. 106.—Mat-treading exercise. (Position. 
6. Make voluntary contraction of the abdominal muscles, 
either standing, or lying on the back, with knees bent up. 
7. Standing. Bend knee to chest and return to position. 
Repeat with other leg, 10 to 20 times. 
Fig. 107.—Mat-treading exercise. (Movement.) For strengthening 
abdominal muscles. 
8. Mat-treading exercise. (See illustration, Figs. 106 and 
107.) From the “Knee-elbow” position—extend legs alter- 
nately, allowing trunk to extend also. Excellent for general 
strengthening of abdominal muscles. 
Exercises inducing deep breathing are useful because the 
downward motion of the diaphragm presses upon the organs 
of digestion and stimulates them to activity. 238 
CON ST IP A TION—D YSMENORRHEA 
DYSMENORRHEA. 
Normally women should not be incapacitated or experi- 
ence pain at the menstrual period, for with them this is as 
natural a function of certain organs as is that of any other 
organ of the human system. The fact that many of them 
are so affected and suffer from dysmenorrhea or painful 
menstruation is well known and may be traced to several 
causes. 
If a woman is to take her rightful place in the professional 
and business world, she cannot, from an economic stand- 
point, afford to neglect the correction of this condition. It 
is a problem which should be met squarely. There must be 
no expectation of special consideration at these periods 
of adjustment of work, so that she may be periodically 
excused from duty. Loss of working capacity from this 
cause has been one of the strongest arguments against the 
relative value of women as compared with men employees. 
There is no reason why a woman cannot, by attention to the 
matter, remove causes so that the function may be almost 
entirely disregarded. This does not, of course, apply to 
conditions of more serious underlying organic causes such 
as displacements. 
If the dysmenorrhea does not disappear after a reasonable 
time, during which there has been a regulation of the 
hygiene and attention to proper exercise, the condition 
should then be investigated by a specialist. 
Causes.—A discussion of the causes of this condition neces- 
sarily involves a consideration of some of the erroneous 
beliefs which formerly existed and which are prevalent to a 
certain extent even at the present time. Among the many 
traditions which have hampered women in the past there is 
probably none which has been more persistent nor which DYSMENORRHEA 
239 
has exerted a more weakening influence upon her physical 
and mental hygiene, than that which has caused the function 
of menstruation to be regarded as an illness and a time when 
the normal habits of living should be altered. 
Apprehension of pain, expectation of disability, concentra- 
tion upon the period, lead to undesirable morbidity and 
start a “vicious circle” of mental and physical depression 
and abnormality. It is incumbent upon those who are in 
charge of girls and young women to normalize this attitude, 
to readjust the mental focus, and to teach the importance 
of health habits which shall result in the prevention and 
remedy of excessive periodic disturbances. 
The idea that bathing at this time is injurious has been 
placed among the false traditions, and it is now generally 
accepted that the warm bath is not only permissible, but 
advisable. 
The tendency to diminsh the accustomed amount of 
exercise has been very general, and its result has been bad, 
as the organs become congested and their function interfered 
with. Further attention will be given to this matter later on. 
Constricting clothing, especially tight bands and corsets, 
which exert a downward pressure on the pelvic organs, are 
factors of evil. Shoes with high heels are pernicious in their 
effect and a frequent cause of displacements of the uterus as 
well as of dysmenorrhea, since the tilting of the pelvis which 
results allows the organs to be thrown out of their normal, 
into a position of strain. Poor posture and visceroptosis, 
both of which are accompanied by weak abdominal muscles 
and sagging of the organs, may also be included as prevailing 
causes. 
One has only to keep in mind the close relation between 
the abdominal and pelvic organs to understand that con- 
stipation and dysmenorrhea are companion miseries because 240 
CONST IP A TION—D YSMENORRHEA 
of the pressure of the distended intestines, especially of the 
rectum, upon the uterus, and that the relief of constipation 
frequently means the relief of dysmenorrhea. 
These causative factors are one and all within the control of 
every woman, and, except in specific cases, if the dysmenor- 
rhea persists the individual is reprehensible, for any woman 
with sufficient vision and will-power can adopt a sane mental 
attitude, acquire strong muscles and a good posture, normal- 
ize her health habits, adjust her clothing and shoes and 
correct constipation. Menstrual irregularities are largely 
due to the same causes and yield to the same treatment. 
Advisability of Exercise.—A subject under much discussion 
is the amount of exercise which should be taken at this 
period. Regular activities should be carried on as a matter 
of course. Walking is beneficial. In the gymnasium the 
work may be continued, but modified at the discretion of the 
teacher. It should be possible for the average student to 
perform all but apparatus and heavy abdominal work. 
Exercise for the arms, legs, trunk and those stimulating 
respiration and the action of the diaphragm are advisable. 
With students in normal schools of physical education the 
gymnastic work should not be discontinued except in special 
cases. 
The following plan has been tried out satisfactorily not 
only with the above-mentioned group, but with students in 
several of the colleges for women. During the period, the 
student reports for work in the individual gymnastic room, 
being excused from the regular class for the purpose, and 
carries out a special program of exercises, under supervision. 
Some students may be allowed a more vigorous program, 
than others, and the individual programs may vary from day 
to day. 
The results of a program of this sort with a group of stu- DYSMENORRHEA 
241 
dents under the observation of the writer have been gratify- 
ing. The conclusions reached were based on data compiled 
by the individual students. A book was provided in which 
each student was asked to record in the form of a diary, 
on sheets especially prepared for the purpose, the date, 
duration of period, prodromal symptoms, pain, a list of exer- 
cises taken, effect of exercise and “remarks.” The result of 
these records showed normalizing of function in practically 
every case; shortening of length of period where it had been of 
too long duration, diminution of pain and lessening of mental 
depression. There had been no ill effects experienced from 
the exercises, in fact a frequent comment was that of “ feeling 
better” afterward. 
In addition to the beneficial effect of the exercises in 
relieving congestion and strengthening the muscles, there is a 
psychic value in continuing exercises. The mental attitude 
produced is distinctly different from that under the sus- 
pension of all exercise and where a line of demarcation is 
drawn, which impresses the girl with the idea that there is a 
periodic time when activity should be discontinued, and 
she is more or less “abnormal.” 
Treatment.—As before indicated, the treatment of dysmen- 
orrhea and menstrual irregularities is primarily the estab- 
lishment of rational thinking and living and a reasonable 
amount of physical exercise. 
Specific Exercise.—The “Mosher exercise,” originated by 
I)r. Cleila Mosher, of Leland Stanford Junior University, is 
so beneficial and simple that it should be practised daily by 
every woman. The exercise is described by Dr. Mosher1 as 
follows: 
“All tight clothing having been removed, the woman is 
placed on her back on a level surface, in the horizontal posi- 
1 Mosher; Health and the Woman Movement. 242 
CON ST IP A TION—D YSMENORRHEA 
tion. The knees are flexed and the arms are placed at the 
sides to secure perfect relaxation. One hand is allowed to 
rest on the abdominal wall without exerting any pressure, 
to serve as an indicator of the amount of the movement. 
The woman is then directed to see how high she can raise 
the hand by lifting the abdominal wall without straining, 
then to see how far the hand will be lowered by the voluntary 
contraction of the abdominal muscles, the importance of this 
Fig. 108 
Fig. 109 
Figs. 108 and 109.—Illustrating “Mosher” exercise. 
contraction being especially emphasized. This exercise is 
repeated 10 times night and morning in a well-ventilated 
room, preferably while she is still in bed in her night-clothing. 
She is cautioned to avoid jerky movements and to strive for 
a smooth, rhythmical raising and lowering of the abdominal 
wall. These-exercises should be taken twice daily every day 
in the month, including the time of menstruation. The 
bladder should be emptied before the exercises are begun. DYSMENORRHEA 
243 
The exercises must be continued over a considerable period 
of time to accomplish any very striking results, long enough 
to develop these muscles and to establish their more or less 
constant use without conscious effort.” 
Typical Program of Exercises. 
1. General relaxation exercises. 
2. Posture training. 
3. Lying on mat. Feet on floor; knees bent. Vigorous 
arm extensions upward, sideways and forward. 
4. “Mosher exercise” (10 times only). 
5. Stride sitting. Trunk bending sideways (Fig. 52). 
6. Stride sitting. Trunk twisting (Fig. 50). 
7. Knee-chest position. 
8. Balance exercises, walking in good posture. 
9. Hook lying (position as in Exercise 3). Relaxation and 
deep breathing. 
Case Record. 
History.—Young woman, aged twenty years. Entered 
school of physical education in September. 
Posture poor; marked ptosis; periods irregular 
with pain; examination by specialist showed 
retroversion of uterus. 
Treatment.—Exercises prescribed: 
1. “Mosher exercise” (Fig. 108). 
2. Knee-chest position (Fig. 67). 
3. Knee-chest position with leg-raising. 
4. Sitting. Trunk circling. 
These were performed five minutes twice 
a day at first; the time increased to ten 
minutes. 244 
CONSTIPATION—DYSMENORRHEA 
Also regular work was done in the gymna- 
sium with special attention to posture. 
Result.—Improvement began to be noticed after two 
months, steadily increasing. After eight 
months, regularity of periods had been estab- 
lished, pain had been reduced to a minimum; 
posture improved and a second examination 
by specialist showed normal position of uterus, 
and no retroversion. CHAPTER XV. 
OVERWEIGHT AND UNDERWEIGHT. 
OVERWEIGHT. 
The tendency to obesity is a specter which haunts the 
footsteps of many people, and the teacher of physical educa- 
tion is consulted frequently in regard to methods of prevent- 
ing or reducing an accumulation of fat. 
Statistics formulated by life insurance companies show 
that underweight in the young is more detrimental to the 
well-being of the individual than overweight, but the over- 
weight is a much less favorable condition in the middle- 
aged and elderly, and is associated with a higher death-rate. 
Obesity is due to overnutrition and underoxidation of the 
tissues, or, in other words, is the result of more food than 
is necessary either in amount or kind, and of too little 
exercise. The result is that fat is deposited, muscles dete- 
riorate, energy diminishes, and even the mental powers are 
dulled. The functions of the vital organs become sluggish, 
and the tax upon the heart is increased. These conditions 
tend to slow down the bodily activities, hasten old age, 
decrease the resistance, and so shorten life. “Weight in 
relation to age is an important factor in influencing longev- 
ity.”1 Besides the above stated disadvantages there is 
definite physical discomfort when the size of the body 
becomes a burden. 
Some individuals are more prone to overabundant flesh 
than others, as there is an inherited predisposition to follow 
1 Fisher and Fiske: How to Live. 246 
OVERWEIGHT AND UNDERWEIGHT 
type. These are usually people of a placid, easy-going tem- 
perament, who have a disinclination to take much exercise. 
The fat accumulates insidiously, especially in those regions 
where there is little muscular activity, as for instance around 
the waist, abdomen, hips, shoulders and neck. In many 
cases there will be excess fat around the internal organs, and 
fatty degeneration of the heart frequently occurs. 
Treatment.—Exercise is an important agent in the treat- 
ment of obesity: However it is not sufficient of itself alone 
but must be accompanied by regulation of the diet, and in 
many cases this means rigid self-denial. If there is a deter- 
mination to follow a program embodying vigorous exercise 
and restriction of the diet, the results will be gratifying in the 
extreme. 
Before entering upon a course of treatment the general 
strength of the pupil must be noted and the heart tested, as 
of necessity exercises should be vigorous and of such char- 
acter as will induce perspiration. 
The process of reducing the weight should be gradual, 
for it is weakening to reduce too rapidly, especially for older 
people. The treatment must always be regulated to the 
individual with reference to age, temperament and any 
existing physical abnormality; the pulse should also be taken 
before and after exercise and the amount of fatigue noted. 
Care must be exercised not to overtax the heart, and a heart 
examination by a physician should be insisted upon previous 
to undertaking a program for reduction. 
Drugs should be avoided, except in extreme cases, and then 
taken only upon the advice of a reliable physician. Many 
of the advertised cures for obesity are disastrous in their 
effects, being frequently of such a nature as will disarrange 
the processes of assimilation and digestion, if they do not 
lead to more serious results. OVERWEIGHT 
247 
Regulation of the Diet.—If possible, it is well to have the 
advice of a physician in regard to diet. In general, it may be 
said that nearly everyone eats too much and that restraint 
may be all the advice necessary in some cases where the 
condition is not extreme. There should be no eating between 
meals; the quantity of sugar, fats and starch should be 
diminished. The menu should contain a greater proportion 
of bulky foods, which are less in caloric value, and salads 
and fruit in abundance; the temptation to indulge in candy 
and desserts should be met with fortitude. 
It is wise to prescribe the diet carefully in the more extreme 
cases, in order that the food may be of sufficient caloric 
value, for when left to the judgment of the individual the 
food selected may not have the requisite nutrient values. 
Dieting of itself alone is inadvisable, since it produces weak 
and flabby muscles and is exhausting. 
A program of exercises should embody both general and 
local work and be so arranged that maximum activity is in 
the middle of the lesson and gradually slowed down to the 
end. Some of the specific exercises for localized action of 
the abdominal and trunk muscles have been described in 
Chapter VII. Note Exercises, Figs. 40, 46, 47, 50, 52, 
53, 56, 58, 61, 63. 
The exercise heel raising, knee bending, with arm raising 
sideways is useful as a general exercise. 
The practice of drawing the abdomen in by voluntary 
contraction of the muscles should be advised. 
For a flabby chin, head bending backward, head bending 
sideways, head twisting and rotation. 
For back of neck (prominence of seventh cervical). This 
unsightly lump accompanied by an accumulation of fat, is 
difficult to remove, but it can be accomplished by persistent 
exercises of the following type: 248 
OVERWEIGHT AND UNDERWEIGHT 
1. Draw head horizontally backward, drawing chin down 
(Fig. 58). 
2. Arms forward bent at level of shoulders. Fists clenched. 
Draw arms and head slowly and forcibly backward. 
3. Bend trunk slightly forward from the hips. Extend 
arms slowly sideways from the shoulders, keeping head back. 
4. Deep massage is helpful also. 
Typical Program for Obesity (Where There is no Heart 
Difficulty). 
1. A quick run around the room, or stationary running. 
2. Relaxation and deep breathing. 
3. Sitting. Trunk-twisting and bending. (See Figs. 50 
and 52.) 
4. Arm and leg flinging on the mat (Fig. 40). 
5. “Jumping-jack” exercises (Fig. 24). 
6. Knee-bending, lying on the mat (Fig. 58). 
7. Prone standing. Slow arm extension sideways. 
8. Standing heel-raising and knee-bending, with arm 
extension sideways. 
9. Aeroplane exercise (Fig. 40). 
10. Practise walking in good posture, with abdomen 
retracted. 
11. “Mat-treading” (Fig. 103). 
12. Hook lying. Deep breathing. 
Relax, and rest. 
Exercises should be performed in a room with free cir- 
culation of air and the pupil should always be encouraged to 
breathe deeply and freely at all times. UNDERWEIGHT 
249 
UNDERWEIGHT. 
The condition of underweight may be the result of several 
underlying conditions and in most cases can be improved 
by exercise. 
As in obesity there is often an inherited tendency and a 
corresponding temperamental propensity to nerve-tension 
and overactivity. 
Imperfect assimilation of food is a frequent cause as are 
also severe mental exertion and worry. 
Treatment.—Underlying conditions should be carefully 
investigated by inquiring into the daily life of the individual 
and ascertaining not only if the occupation is such as may 
produce excessive fatigue, physical or mental, but also 
whether or not there are cares and worries, and if proper rules 
of hygiene are being observed. The regulation of these con- 
ditions is a necessary feature of the treatment. 
In the individual who is underweight the tissues are not 
sufficiently nourished, the muscles have become weak and 
flabby, and the output of energy being greater than the supply 
there is overtaxing of the organism and chronic fatigue. 
There is a probability that the food is insufficient in nutritive 
value, or is not properly digested or assimilated. It follows, 
therefore, that attention to diet and digestion is important 
in the treatment. 
It will be noticed that people who are underweight are 
often precarious in their appetites and should be encouraged 
to regulate and increase their diet, and to include therein 
foods containing liberal amounts of starches, sugars and 
fats. Other essentials are: drinking plenty of water, and 
obtaining sufficient rest and sleep. 
Exercise is very beneficial, as it improves the general cir- 
culation, stimulates the activity of the digestive organs and 
thereby assists assimilation and regulates the metabolism. 250 
OVERWEIGHT AND UNDERWEIGHT 
It should also aid powers of relaxation and be restful to the 
nerves. 
Exercises should be given slowly and not too vigorously 
at first; they should be such as to arouse the interest, and 
much attention should be given to relaxation. The use 
of a victrola is very helpful in work of this nature as it helps 
to make the individual less subjective and enables one to 
perform the exercises with less tension. 
Some of the simple class exercises in the repertoire of every 
teacher of physical education may be used in planning a 
program to meet these needs. 
It is usual to find a condition of constipation, and two or 
three specific exercises should be included in the program. 
Care must be taken to begin with a simple lesson and not 
overtax the pupil. It is wise to give exercises in the recum- 
bent position almost entirely if there is little physical strength. 
The pulse should be noted. 
Program of Exercises for Underweight. 
1. Relaxation exercises. 
2. Deep breathing. 
3. Training for posture. 
4. Lying on the mat. Knees bent, feet on floor. Slow 
arm flinging in various directions. 
5. Lying on mat. Legs extended. Alternate leg raising. 
6. Sitting. Trunk bending and circling. (See Chapter 
VII.) 
7. Bicycle exercise. 
8. “Mosher exercise” (Figs. 108 and 109). 
9. Lying on back. Extending dumb-bells sideways 
(Fig. 31). 
10. Relaxing exercises in standing position. 
11. Walking in good posture. 
Rest and relax. CHAPTER XVI. 
INDICATIONS FOR EXERCISE IN ABNORMAL 
HEART AND THYROID CONDITIONS. 
This short chapter has been added because of the many 
inquiries by teachers and students of physical education as 
to the advisability of exercise for pupils exhibiting either a 
heart weakness or an abnormal condition of the thyroid 
gland. If exercise be deemed advisable, the succeeding 
questions are as to the type of exercises, and the amount of 
responsibility which may be assumed safely by the instructor. 
It will be the purpose here to answer briefly these questions 
and to indicate lines of procedure. 
In General.-—Both conditions can be benefited by exer- 
cises carefully graded and intelligently applied. 
A medical examination with the subsequent diagnosis and 
advice of a physician must always be the basis of any pro- 
cedure by the instructor in the planning and application of 
an exercise program. 
ABNORMAL HEART CONDITIONS. 
1. Aims of Exercise. 
(a) Improvement of the peripheral circulation. 
ib) Strengthening the heart muscle. 
(c) Deepening the respiration. 
0d) Normalizing the action of the cardiac nerves. 
251 252 
ABNORMAL HEART CONDITIONS 
2. Exercise tolerance. 
The pulse should be taken both before and at the end 
of the exercise period, and a return to normal or 
slightly below, after a short rest, would be an indi- 
cation that the demand upon the heart had not been 
excessive, but within the tolerance of the individual. 
3. Character of Exercises. 
Exercises should be of the type not demanding forced 
or sudden effort, or be of prolonged duration. They 
should be of a general character: simple arm and leg 
movements are excellent, given at first in the lying 
or sitting position. Rhythmical exercises are valu- 
able. As joint action is most beneficial in its effect 
upon bloodvessels, even the simplest flexions and 
extensions of the joints can be used. 
No exercise should be given in the hanging posi- 
tion, or with arms extended over the head, although 
exercises of this type may be reached in progression 
as the condition improves. 
4. Supervision. 
Careful supervision is necessary. The pupil should 
be watched for indications of fatigue or over-exer- 
tion, some of the signs being cyanosis, sighing, breath- 
lessness, and palpitation. Also, holding the breath 
must be avoided. 
5. Progression. 
There should be steady progression, and the exercise 
tolerance increased as rapidly as possible. Much 
depends upon the discernment of the teacher and 
the correct application of the exercises. The results 
reached in the experience of the author and of others, 
in the improvement of these conditions through 
exercise have been most gratifying and the progress 
made in many cases almost astonishing. THYROID ABNORMALITIES 
253 
The value of exercise in the relief of heart difficulties is 
being increasingly recognized. In this connection the well- 
known methods of Schott and Oertel should be mentioned. 
The Schott system consists of carefully graded resistive exer- 
cises combined with mineral baths, the original being at 
Bad Nauheim, and the treatment known as the Nauheim 
method. The Oertel system is, briefly, the improvement of 
the heart by mountain climbing, with a regulation of diet. 
THYROID ABNORMALITIES. 
Physical examinations of individuals in schools, colleges, 
and other institutions by doctors and physical education 
teachers are revealing a surprising number of abnormally 
functioning thyroid glands. In some sections of the country 
this situation is more extreme than others. The question 
arises here also as to the benefit which may be derived from 
exercise. As before stated, certain types of exercises are 
helpful, but a previous medical diagnosis should be insisted 
upon. 
The two types of abnormal conditions are the hypothyroid, 
and the hyperthyroid. In either case the exercise treatment 
is the same, the object being to normalize the secretion of 
the gland, and to bring the individual up to a better general 
condition. 
Medical Treatment.—It may be desirable in addition to 
the exercises, to help improve the condition by the admin- 
istration of iodine, but this should always be done upon the 
advice of the physician. This treatment is being given in 
some localities as a routine preventive measure, where goiter 
is endemic, with successful results. 
Exercises.—Much the same procedure should be followed in 
the planning and application of exercises for the abnormal 254 
THYROID ABNORMALITIES 
thyroid conditions as for the heart. Exercises of a general 
character, not too taxing, should be chosen. The progression 
should be gradual and as rapid as possible. There is often 
a tendency to abnormal self-consciousness which it is desir- 
able to minimize. 
No exercises necessitating tension in the neck should be 
given, or strenuous head and neck movements. Many of 
the enlarged thyroids are called “postural,” as an improved 
posture of the head in these cases, relieving pressure on the 
glands, results in a diminution in their size. 
There is often a tendency to a weak heart as an accompani- 
ment to these conditions which the instructor should bear 
in mind when planning exercises. 
BIBLIOGRAPHY. 
Alexander: Man’s Supreme Inheritance. 
Bancroft, Jessie: The Posture of School Children. 
Bolton: Exercises for Women. 
Bowen, W. P.: Applied Anatomy and Kinesiology. 
Bucholz: Therapeutic Exercise and Massage. 
Call, Anna Payson: Power through Repose. 
Fisher and Fisk: How to Live. 
Fox: Physical Remedies. 
Heatherington, Clark: A School Program in Physical Education. 
H’Doubler, M. N.: Manual of Dancing. 
Kellet-Smith: Lateral Curvature of the Spine and Flat-foot. 
Lippit: A Manual of Corrective Gymnastics. 
Lovett, Robert: Lateral Curvature of the Spine and Round Shoulders. 
Lovett, Robert: Treatment of Infantile Paralysis. 
McKenzie: The Action of Muscles. 
McKenzie, R. Tait: Exercise in Education and Medicine. 
McKenzie, R. Tait: Reclaiming the Maimed. 
McMillan: Massage and Therapeutic Exercises. 
Mosher, C.: Health and the Woman Movement. 
Skarstrom, William: Gymnastic Kinesiology. 
Thomas and Goldthwait: Body Mechanics and Health. 
Walsh: Health and Will Power. 
Wide: Medical and Orthopedic Gymnastics. 
Wilbouchewicz: Atlas Manuel de Gymnastique Orthopedique. 
Reprints and Monographs. 
Anderson, W. G.: Posture—A Cause and Remedy in Enteroptosis. 
Bradford, Stella: A Study of Backs and Chests. BIBLIOGRAPHY 
255 
Brown, Lloyd: A Combined Medical and Postural Examination of 
746 Young Adults. 
Goldthwait, Joel: An Anatomic and Mechanistic Conception of 
Disease. 
Goldthwait, Joel: The Real Significance of Visceroptosis. 
Lewis: The Etiology of Scoliosis. 
Lovett, Robert: The Superstition of Flat-foot. 
Lovett, Robert: History of Scoliosis. 
Lovett, Robert: The Relation of Scoliosis to School Life. 
Mills, N.: Congenital Malformations of the Vertebrae. 
Sever: Anterior Poliomyelitis. 
Sever: The Value of Diagnosis in Back Lesions. 
Sweeny, M.: Gymnastics for Crippled Children. 
Truslow, Walter: The Non-operative Treatment of Scoliosis. 
Whitman, Royal: A Consideration of the Characteristics of Weak 
Foot. 
Wright, Wilhemine: Muscle Training in the Treatment of Infantile 
Paralysis. INDEX. 
A 
Abdomen, 56 
Active exercises, 27 
Adams position for rotation, 169 
Adams, W. Curtis, 114 
Adenoids, 60 
Adjustable seats, 65 
Anatomy of foot, 191 
of human body, 33 
Antagonistic muscles, 37 
Anterior metatarsalgia, 206 
poliomyelitis. See Infantile 
paralysis. 
Antero-posterior faulty postures 
20, 53. 
plane, 38 
Apparatus for corrective gymnas- 
tics, 22 
Arch supports, 205 
Arches of foot, 191, 192 
Assistive exercises, 27 
B 
Bancroft, Jessie, 79, 90 
Bicycle exercise, 114 
Bodily mechanics, 137 
Braces, 89, 180, 231 
Brackett, Dr. E. G., 164 
Brassieres, 72 
Breathing, 99 
Brown, Dr. Lloyd, 86 
Bunions, 209 
C 
Caries of spine, 53 
Chest, 56 
Clothing, influence of, 71, 158 
17 
Compound scoliosis, 144 
Concentric exercises, 27 
Congenital defects, 151 
Constipation, causes, treatment, 
exercises, 232-238 
Corrective gymnastics, 21 
Corrective group exercises, 129- 
134 
Corset for ptosis, 137 
D 
Dancing, fundamentals of, 102 
Defective eyesight, its influence on 
posture, 69 
hearing, its influence on posture, 
69 
Desks, 65 
Dewey, Dr., 31 
Dysmenorrhea, cause, treatment, 
exercises, 238-244 
E 
Eccentric exercises, 27 
Economic value of good posture, 48 
Equipment of gymnasium, 22 
Esthetic value of good posture, 50 
Etiology of antero-posterior faulty 
postures, 58 
of scoliosis, 151 
of weak and flat feet, 199 
Eversion, 218 
Examination for faulty postures in 
the antero-posterior plane, 77 
for scoliosis, 165 
Exercises for antero-posterior 
faulty postures, 97-128 
for constipation, 235-238 
257 258 
INDEX 
Exercises for dysmenorrhea, 243 
for feet, 218 
for heart, 251 
for overweight, 247, 248 
for relaxation, 101 
for scoliosis, 177, 178, 182-191 
for thyroid conditions, 253 
for underweight, 250 
F 
Fashion, its influence on posture, 
73 
Fatigue postures, 62 
Feet, anatomy of, 191 
arches of, 191, 192 
flat, 197 
shape of, 192 
strained, 197 
types of, 211 
weak, 197 
Flat back, 52 
Foot exercises, 218 
Foot games, 224 
Foot records, 203 
G 
Goldthwait, Dr. Joel, 47 
Grading posture, 81 
Gravity, influence of, 43 
Group correctives, 129-134 
Gymnasium shoes, 24 
suit, 23 
H 
Habit, 60, 158, 159 
Hallux valgus, 209 
Heart, 251 
Hibbs, Dr. R., 180 
High heels, 137, 207, 214 
Hip, prominent, high, 170 
History of medical gymnastics, 18 
of scoliosis, 181 
Hollow back. See Lordosis. 
Hygiene, 70, 177 
Hygienic value of good posture, 70 
I 
Inclination of pelvis, 39, 46, 57, 
103 
Individual gymnastics, 21, 24 
Infantile paralysis* symptoms, 
treatment, 225-231 
Inflared foot, 211 
! Intra-abdominal pressure, 136 
Inversion, 218 
K 
Kypholordosis, 55 
Kyphoscoliosis, 148 
Kyphosis, 54 
L 
Lateral curvature of spine. See 
Scoliosis. 
: Lesson, length and frequency of, 
25 
Ligaments, 36, 150 
| Lordosis, 54 
Lovett, Dr. Robert, 141, 231 
M 
McKenzie, Dr. R. Tait, 162 
Massage, 204, 208, 229, 234 
Measurements of antero-posterior 
faulty postures, 79 
Medical gymnastics, 17 
Mental attitude, importance of, 
88, 176 
Mirrors for gymnasium, 22 
Morton’s toe, 207 
Mosher, Dr. Cleila, 77, 241 
Mosher exercise, 241 
Movements of spine, 41 
Muscle training in infantile paral- 
ysis, 229 
Muscles, 36, 150 
Muscular weakness, 59, 160 
N 
Neuro-muscular control, 101, 178 
Non-resistant round shoulders, 57 
O 
“Ode to posture,” 95, 96 
Old theories in regard to scoliosis, 
164 259 
INDEX 
Operative treatment for scoliosis, | 
180 
Orthopedics, 19 
Outflared foot, 211 
Overweight, cause, treatment, 245- 
248 
P 
Pantograph, 75 
Parent’s responsibility, 70, 176 
Passive exercises, 26 
“Pedograph,” 204 
Pelvis, 35 
inclination of, 39, 46 
position of, 57, 103 
Photograph, 81, 173 
Physiological curves of spine, 38 
Planes of body, 38 
Plaster jackets, 179 
Plates (arch supports), 205 
Plinth, 23 
Poise, exercises for, 124 
Posters, 94 
Posture, 41, 44, 45, 94 
drives, 91 
League, 90, 211 
values of, 47 
Pott’s disease, 53 
Program, plan of, 28, 88, 97 
Pronation of foot, 198 
Psychology of individual gymnas- 
tics, 30 
Ptosis. See Visceroptosis. 
R 
Records, antero-posterior faulty 
postures, 79 
feet, 203 
scoliosis, 172 
Regions of spine, 34 
Relaxing exercises, 101 
Resistant round shoulders, 57 
Resistive exercises, 27 
Ribs, 35, 147 
Rickets, 162 
Rotation, 146 
Round back, 54 
shoulders, 53 
Rubber stamp for records, 174 
s 
Scapulae, 35, 56, 150 
Schematograph, 81, 173 
School books, 69, 156 
seating, 61, 65, 155 
Schools, influence of, on posture, 61 
on scoliosis, 154 
Scoliosis, 20, 141 
compound, 144 
postural, 142 
simple, 144 
structural, 144 
Shoes, 24, 74, 207, 208, 210 
for children, 214 
Sitting exercise, 125 
posture, 125 
Social values of posture, 49 
Soft bone, 162 
Spine, 33 
Stereopticon, 90 
Stockings, 213 
Stoop shoulders, 54 
Straight foot, 212 
position in walking, 194 
Superincumbent weight, influence 
of, 163 
Swedish system, 19 
T 
i Teacher’s posture, 69 
responsibility, 30, 69 
Tendo Achillis, 201, 216, 222 
Thorax, 35, 150 
J Thyroid conditions, 253 
Transverse plane of body, 38 
Treatment, of antero-posterior 
faulty postures, 86 
of feet, 204 
of scoliosis, 174 
Triple posture test, 90 
Tuberculosis of spine, 53 
Typical exercise programs, 125 
flexible round back, 126 
lordosis, 128 
stiff round back, 125 
hollow back, 127 
u 
Underwaists, 73 
Underweight, causes, treatment, 
249 260 
INDEX 
V 
Values of posture, 47 
Ventilation, 60 
Vertebrae, 33, 128 
Vertebral column, 33 
Visceroptosis, 48, 135-140 
W 
Walking, analysis of, 218 
mechanics of, 195 
Window pole test, 79 
Writing position, 68 
X 
X-ray, use of, for diagnosis, 152 
Y 
Y-ligament, 36