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JAMES J. DAVIS. Secretary





Bureau Publication N o . 164


Federal Reserve Bank of St. Louis

c h il d r e n ’ s b u r e a u


a d d it io n a l c o p ie s m a y


15 C E N T S P E R C O P Y
Federal Reserve Bank of St. Louis

S lo*. 1
I l Ç S cl
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Letter o f transmittal--------------------------------------------- -------------------------------------------Importance of good body mechanics---------------------------------------------------------------Definitions of posture grades and body types------------------------------------------------Results of poor posture------------------------------------------------------------ 1------------_------- Purpose and scope of a posture clinic___ ;______________ I # ------------------1----------Organization of a posture clinic_________________ _-------------------------------------------Record taking and physical examination------------------------------------------------------Method of teaching posture to children______________________________________
Sum m ary_________________________________________________________________________


Fio. 1.

Skeletal form of a person with good bodymechanics_______________
Skeletal form of a person with poor body mechanics_____________
Posture standards— Stocky-type g ir ls_______________________________
Posture standards— Stocky-type b oy s_______________________________
Posture standards— Thin-type g ir ls_________________________________
Posture standards— Thin-type boys__________________________________
Posture standards— Intermediate-type girls__________________________
Posture standards— Intermediate-type boys___________________________
Tracing o f the contour of the chest of a person with good posture13
Tracing o f the contour of the chest o f a person with poor posture13
Profile silhouette o f the body form at the beginning o f a school
year ________________________________________________________ facing__
Profile silhouette of the body form at the end of a school year
with posture training_______________________________________facing_
Passive pectoral stretching exercise_________________________ facing_
Child in resting position_____________________________________ facing_
Chest expansion with deep inspiration________ _____________ facing__
Manual “ coaching” to increase: chest expansion___________ facing_
Tracing o f the body form by means of the schematograph_________
Method o f correcting poor posture in the supine position__________
Alternate arm raising while good posture is maintained in the
supine position__________ _____ __________
Straight-leg exercise with one thigh flexed on the abdomen_______
Double leg exercise________________________________________________________ 25
Retraction o f the abdominal muscles and contraction of the but­
tock muscles to assume correct posture against the w all_______
Method of correcting poor posture in the erect position____ _______
Method o f walking away from the w all after correct posture has
been attained there_________________________________________________
Trunk forward-bending exercise_____________________________________
Diaphragmatic-breathing exercise_____________________ - _____________
Active pectoral stretching exercise__________________________________

Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis


U . S. D

L abor,
C h il d r e n ’s B u r e a u ,

epar tm en t of

'Washington, September 21, 1926.
S i r : Transmitted, herewith is a report on Posture Clinics; organi­
zation and exercises, by Dr. Armin Klein, director o f the posture
clinic o f the Massachusetts General Hospital. The exercises in this
report are corrective, designed for children who are suffering from
the effects o f poor posture, and.for use in clinics, just as the exercises
in the bulletin entitled “ Posture Exercises ” are preventive, designed
for the normal child and for use in schools.
Acknowledgment is made to Drs. Joel E. Goldthwaite, Robert B.
Osgood, and Lloyd T. Brown, and to Dr. Martha M. Eliot, director
o f the child-hygiene division o f the Children’s Bureau, for helpful
Respectfully submitted.
G r a c e A b b o t t , Chief.
Hon. J a m e s J . D a v i s ,
Secretary of Labor.
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis



After infancy the child learns to stand and walk, and growth is
then constituted more on a physiological than on an anatomical
basis. Transition from the supine and prone positions to the up­
right position tends to strain the stabilizing and supporting frame­
work o f the body, and the result sooner or later is usually a com­
plete or partial exhaustion o f the postural muscles from the pull o f
gravity. Descent o f the ribs and general ptosis follow. By early
adult life this becomes more noticeable because o f its increase with
growth. The posture o f the average man, because o f the force o f
gravity and the influences o f growth and civilization, becomes
drooped or ptotic. W ith the consequent derangement o f the elab­
orate mechanism maintaining the erect posture o f the body comes y
derangement in position o f the viscera, which manifests itself fre­
quently in obscure but distressing ailments o f later life.
Bacteria, foods, and poisons are important influences affecting the
existence and functions o f the human organism that have been receiv­
ing due consideration, and the results are strikingly shown in the
lengthened expectation o f life; but chronic ailments not due to
infections, deficiency diseases, or toxins, but to continued habits o f
wrong living and maladjustments o f the individual body to its
environment should also be combated. Posture at present is not
taught correctly in the family, at school, or by the medical profes­
sion as a whole, as is shown by the results o f physical examinations
at schools and colleges and o f the Army examinations during the
W orld War. Poor posture is far more prevalent than good posture, t—
It is present in children o f lower school grades and is not outgrown
in later life. In fact, defects o f posture noted in small children o f
school age are duplicated in college students and vice versa. To
relieve these children suffering from ailments due to their poor
posture, posture clinics are definitely necessary, just as necessary as
those relieving sufferers from chronic ailments due to other causes.
The program o f the future is so to train the individual from
early life as to prevent many o f the present ailments which are due
to poor posture. His interest in his own maximum physical effi­
ciency should be aroused by education. He should realize that the
freer and more economical use o f the body not only will prevent
the chronic ailments that may be due directly to poor posture but
by conserving energy will add to the body’s power to resist disease
and thus prolong still further the period o f vigor for man. Thus
the teaching o f good posture is a phase o f preventive medicine which
should aid in combating at their outset not only diseases primarily <—
due to poor body mechanics but also those functional conditions for
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which poor posture is responsible. Good posture by insuring effi­
cient use o f the body may increase the resistance o f the body to
invasion by outside noxious agents.
Since instruction in the intelligent care, nurture, and training o f
the body will be most effective if given at an early age and to large
groups, such instruction should be given in the schools. When
this instruction has a recognized place in the curriculum, education
will include in its aim the habitual correct use o f the body as well
as o f the mind.
Even when posture is generally taught in the schools, however,
some posture clinics will be necessary to care for children requiring
special attention, and until that time the posture clinic with its cor­
rective work fills an especially important role. It is the purpose o f
this pamphlet to discuss the organization of such clinics for the
purpose o f treating some o f the chronic ailments o f the individual.
From the experience and insight gained from such corrective training
o f individuals or small groups it has been possible to derive standards
for the instruction of large groups so as to prevent incorrect body
posture and its sequelae.1

The body is in good mechanical position when the weight of it rests
evenly on the heads o f the femurs; i. e., the hip joints. In this posi­
tion the head is balanced above the shoulders, the chest is elevated,
and the breastbone is the part o f the body farthest forward. The
lower abdomen is retracted and flat, and the back curves are within
normal limits. In the standing position the hip joints in lateral
view are directly in line with the Knees and ankle j oints. In this ideal
standing posture a perpendicular dropped from the ear^ or just be­
hind it, would fall through the shoulder, hip, and ankle joints. The
anterior groups o f muscles, in a state of tonus or o f postural or re­
flex contraction, are balanced 2 by similar action o f the posterior
groups of muscles. This static or postural contraction used in sus­
taining the erect position may be continued indefinitely as it is main­
tained by the sympathetic nervous system. The normal individual
therefore maintains his erect poise with ease, and the skeletal, muscu­
lar, and visceral systems are in proper relationship to function
In Figure 1 (p. 3) the head is held equipoised above the shoulders
so that there is no undue strain on the muscles o f the neck and the
blood will flow easily and freely to the brain. This makes for men­
tal alertness and vigor.
The chest is held up; “ costal” breathing will be unrestricted.
The limits o f chest expansion will be reached freely and easily, and
the lungs therefore will be well aerated. The heart also will not be
handicapped in its action. The diaphragm will be elevated and
dome shaped, in position for fullest activity and expansion; this
will insure fullest aeration o f the lungs from the complementary
diaphragmatic, or abdominal, breathing.
i gee Posture Exercises; a handbook for schools and for teachers of physical educa­
tion (U. S. Children’s Bureau Publication No. 165, Washington, 192b).
a Sherrington, C. H., M. D .: “ Posture.” The West London Medical Journal, Vol. XXV
(1920), pp. 97-106.
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Skeletal form of a person with good body mechanics (Mg. 1)
and of a person with poor body mechanics (Fig. 2)
5795°— 26------2
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postu re


The curves o f the spine are normal. The segments are balanced
on one another, with minimum tension on the muscular and liga­
mentous stays o f the spine. This evenly distributed tension will
prevent overstrain on certain parts and the pain that frequently*
accompanies it.
The lower abdominal muscles are retracted, and the abdominal
wall furnishes the necessary support for the abdominal organs in
their proper places in the upper abdominal cavity, thus preventing
them from sagging. It has been shown that retraction ox the lower
abdomen is sufficient to raise the stomach and the adjacent organs
1 to 5 inches into the upper abdominal cavity. Food can then pass
readily through the stomach and small intestines.
Because the head is held erect, because the chest is up, because
the curves o f the spines are not exaggerated, and because the lower
abdominal muscles are retracted the person whose posture is diagrammatically shown in skeleton form in Figure 1 will function
with good balance and form, gracefully, smoothly, efficiently, alertly.
A body with variations from the ideal pictured in Figure 1
(p. 3 )—that is, with forward head, drooping chest, hollow back,
and protuberant abdomen—has poor posture, the degree depending
on the amount o f variation.
In Figure 2 (p. 3) the neck muscles from the upper back to
the occiput are strained because o f the drooped head, and strained,
aching, upper-neck muscles are conducive to weakness and list­
The chest has dropped and the antero-posterior diameter is thereby
decreased. The ribs so slant from their attachments at the spine
that they drop into the chest and so narrow its diameter. This
means a definite handicap to the action o f the lungs and heart.
Because the chest has dropped, the sides o f the thorax, originally
well rounded (as in fig. 9, p. 13), often become more angular and
flattened (as in fig. 10, p. 13). In this flattened chest the dia­
phragm has not the rounded contour at its origin that is necessary
to give it the normal dome shape. It sags relaxed. Its tone de­
creases. Its excursion becomes shallow.3 Under these conditions
the lungs can not be well aerated.
The normal curves o f the spine are exaggerated, and the mus­
cular stays o f the spine must exert themselves unduly in order to
support the body in the erect position. Energy must be expended
to balance the slumped body—energy that otherwise might be
utilized for ordinary daily needs or stored to increase resistance to
disease. I f the strain becomes too great, the energy wasted consti­
tutes an absolute deficit, and pain finally appears in the support­
ing muscles, most commonly in the lower back and the base o f the
skull. The chest is flattened and dropped and the abdominal mus­
cles become relaxed and lose their tone. Thus the vicious circle is
completed, as these muscles “ take up slack” and tend to stabilize
the parts in their faulty position.
The pelvis is tilted forward, and this faulty position tends still
further to relax the abdominal supports and to allow the abdominal
organs to drop downward toward or into the pelvis. Constipation,
8 Brown, Lloyd T., M. D .: “ Bodily mechanics and medicine.”
and Surgical Journal, Vol. CLXXXII (1920), pp. 649-655.
Federal Reserve Bank of St. Louis

The Boston Medical



painful menstruation, even the cyclic vomiting of children, it is
believed, may be due to these malpositions.
Because the head is dropped downward and forward; because the
chest falls down and inward, becoming flat and angular at the sides;
because the normal curves o f the spine are exaggerated; and because
the abdominal muscles are relaxed, the person whose posture is diagrammatically shown in skeleton form in Figure 2 is forced to
maintain his equilibrium by overexertion o f his spinal muscular
supports and by flexed or overextended knees. He is a slouchy, un­
graceful, inefficient, uninspiring individual whose functioning is
impaired as a result o f poor body mechanics.
Posture grades.

Some persons use their bodies like the ideal pictured in Figure 1,
the alignment o f their body parts being perfect; others do fairly
well but not so well as the first group; some stand poorly, and some
very poorly. Thus individuals may be classified readily into four
grades o f body carriage— excellent, good, poor, and bad; or A , B, C,
and D (figs. 3, 4, 5, 6, 7, 8, pp. 7-12).
The indexes o f excellent posture (A ) are, first, head balanced above
the shoulders, hips, and ankles; second, chest elevated with the
breastbone the part o f the body farthest forward; third, abdomen
flat and drawn in below but free and mobile above; and, finally, nor­
mal unexaggerated back curves.
In good posture (B ) the head and chin are inclined slightly for­
ward. As a result the chest drops a little, and the upper part o f the
back inclines somewhat backward. The abdomen, though perhaps
rounded, does not protrude. The lower, or lumbar, spine follows, as
it were, the abdomen, and the hollow back shows its first signs o f
In poor posture (C ) the head is plainly forward, and the chin pro­
trudes. The curve from the back o f the head to the lower end o f
the shoulder blades is elongated and accentuated. The chest has
dropped until it is flat. The relaxed abdomen protrudes, and the
lower back is hollow.
In bad posture (D ) the head is allowed to drop forward. The
chin is dropped. The chest is sunken. The upper truck has swayed
backward. To maintain equilibrium the forward inclination o f the
lower spine is markedly increased. The back curves are therefore
extremely exaggerated. W ith the sinking o f the chest the abdomen
drops, relaxed and protuberant. The knees are sometimes bent for­
ward, sometimes sprung backward. The. relaxation is complete:
W ith classification according to grade of body carriage comes an
appreciation o f the severity o f body defects that the subject must
overcome to improve his posture. Obviously a child with a D rating
has farther to go than the C child, who in turn has farther to go than
the B child before they all acquire A posture. The examiner there­
fore can prognosticate which groups o f children, other things being
equal, will take longer to learn to maintain a correct attitude. His
findings can be passed on to the instructors to enable them to train
their patients in body mechanics more sympathetically and intelli­
gently. The patients themselves are stimulated to correct their poor
posture. Since the characteristics o f the posture grades are defined,
the child when graded knows exactly what he must correct. I f he
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has ordinary ambition he will be stimulated to correct his body de­
fects in order to advance his rating.
Classification according to body type.

It becomes apparent that gradations in body carriage vary with in­
dividuals. Generally speaking, the indexes o f bad posture are the
same in two given persons, although they may appear to differ
greatly. Basic differences in body structure determine the specific
appearance o f individuals classified in the various.posture grades.
Stocky individuals, as they assume the relaxed attitude, lean back­
ward from the middle o f the back, the dorsolumbar junction (figs.
3, 4 ). Thin individuals with poor use o f their bodies sway back­
ward from the lowest part o f the spine (figs. 5, 6). The pelvis
at the same time is tipped forward. Individuals o f the intermediate
type, as they deviate from good poise, bend backward not at the
middle o f the back as do the broad, stocky persons, nor at the low­
est part o f the spine as do the thin persons, but midway in the lower
back or lumbar spine (figs, 7, 8). These three types o f anatomical
structure—broad, intermediate, and thin—are easily recognized if
seen “ pure.”
The thin type has a torso long and slender or delicate and narrow
and a long, thin neck. The length in the lumbar region is striking.
Frequently there may even be six lumbar vertebrae instead o f the
usual five. The elongated spine gives more flexibility, and this ex­
plains the marked slump, or ptosis, possible in these persons. They
sometimes look as i f some heavy force were pushing them down from
above; so much so that they sway far backward in the upper back
and protrude far forward in the lower back, the pelvis tipping for­
ward with the lower spine. The shoulders may become markedly
rounded and forward and the shoulder blades scaphoid. The ex­
tremities and their muscles are usually long and slender.
The broad type includes the heavy-looking, “ broad-backed ” per­
sons with large skeletons. The neck is short and “ chunky.” The
torso is* broad and relatively short. The lumbar region is short,
sometimes because there are only four lumbar vertebrae instead o f the
usual five and sometimes because the sacrum is set well down between
the hip bones. Because o f the very construction o f the spine the
lumbar curve is less marked. Flexibility is lacking in this sturdily
built spine. The extremities are large and broad. This is the type
that tends to be obese.
. .
In the intermediate type the torso is a compromise in length and
breadth between the othef two types. The normal rounded curves
o f the spine, i f they become exaggerated, appear mild and gradual.
The sharp “ corners ” o f the thin type and the large fatty deposits of
the broad type are missing. The neck may be almost as long as that
o f the thin type; or it may be short, though hardly so thick and
“ chunky ” as in the broad type. The musculature is firm. Flexi­
bility or the spine, though not so marked as in the thin type, is much
greater than in the broad type. This intermediate class is hetero­
geneous; it should include all individuals that do not fall readily
into either o f the other groups. After study and experience the fun­
damental characteristics o f the thin and stocky types will ordinarily
be seen to predominate sufficiently in the individuals examined to war­
rant classification in one o f these types. When, however, characteris
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StocKy-Type Girls

Excellent Good







Children's Bureau, United States Department of Labor, W ashington, p.ç,i9£S.

F ig. 3
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StocKy-Type Boys

Excellent Good



if i f




Children's Bureau, United States Department of Labor, W ashington, a c ,1925.

F ig. 4
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Thin-Type Girls

Excellent Good







Children's Bureau, United sta te s Department of Labor, Washington,o.C,l9£8.

F ig . 5
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Thin-Type Boys

Excellent Good





Children's Bureau, United S tates Department of .Labor, W ashington,0.C, 1926.

F ig . 6
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Intermediate-Type G irls


Excellent Good








1. Head forward.

l.Head marKedly

2. Chest flat.

a Chest depressed

3. Abdomen relaxed
¿Part of body,far­
thest forward.)
4. BacK curves exag­

a Abdomen complete­
ly relaxed and pro­
tuberant. .
4 BacKcurves extreme
ly exaggerated.

Children's Bureau, United States Department of Labor, W ash in g ton ,0.0,1926.

P ig . 7
5795°— 26----- 3
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Intermediate-Type Boys

Excellent Good


1. Head up-chin in.
(Head balanced
above shoulders,
hips,and ankles)
S. Chest up
(Breast bone the
part of body far­
thest forward)
3. Lower abdomen in,
and flat.
4 Back curves with­
in normal limits.

Children1» Bureau, United sta te s Department of Labor, W ashington, ac,«M6.

F ig . 8
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tics peculiar to these types do not so stand out, classification in the
intermediate type is .logical. In this group should fall those who
might have a tendency toward thin or broad characteristics but do
not actually possess them.
Corrective needs of the different types.

When classification as to body form has been completed it is clear
what may be expected o f the individuals o f different types. The
broad type usually are fitted anatomically for slow, heavy, “ labor­
ious ” work; the thin type for work requiring speed or agility; and
the intermediate type for either kind of work according to whether
their physical characteristics incline more to one group or the other.
I f in the industrial world employees were selected according to the
anatomical types best fitted for special kinds o f work, they would
be more efficient individuals, more efficient employees, and more effi­
cient members o f society.
It should also be remembered that with classification o f body type
comes appreciation o f the effort necessary for any person to main­
tain good body carriage. The broad type leaning backward only
in the upper spine has to be taught principally to mobilize the chest
and to keep it raised in order to straighten the spine. Attention in

Tracing o f the contour of the chest (at about the lower level of the shoulder blades) of a
person with good posture (Fig. 9) and of a person with poor posture (Fig. 10)

that case should be concentrated on exercise o f the upper thorax and
head. A slight amount o f “ pelvic r o ll” is usually necessary to
balance the lower back. Then the body mechanics is corrected.
The problem with the thin type is greater. The long, thin, willowy
bodies are easily contorted into almost grotesque shapes. As has been
mentioned, some persons o f this type appear to be laboring under
the effects o f a compressing load at the upper end o f the spine. First
the pelvis must be rolled backward; usually it has tipped so far
forward that it is rather difficult to get it back to its ideal inclina­
tion. Then the upper chest must be balanced over the pelvis and
lower back. This again is often quite difficult. A t first in bringing
the thorax and head into proper position the patient is likely to
lose the correct position he has just learned for the pelvis and lower
back. But with patience on the part o f the instructor and diligence
and assiduity on the part o f the patient good body mechanics is
finally learned. It is most difficult for the thin type, however, and
this should be understood in training them.
The persons o f the intermediate type are hardly so limber and
willowy as the thin type but are more flexible than the broad type.
Some individuals, perhaps, will find it hard to roll their pelvis and
lower back into proper position; others will find it more difficult to
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balance the chest and head on the fixed lower back and pelvis. In­
struction should be directed to the difficulty and concentrated there.
The very fact that the patient can not easily correct the maladjust­
ment o f posture associated with his anatomical structure is a clear
indication that individual instruction is essential.
The examiner classifying individuals according to grades o f pos­
ture and physique can, from his knowledge o f the workings of the
different types, direct the attention o f the instructor to the part o f
the body where correction is most needed.

When the body is not in proper mechanical position it must func­
tion with some o f its vital parts out o f alignment. The human body
may then compensate for this strain through its inherent reserve
power. Once this ability to compensate is lost, however, symptoms
o f deranged physiology may appear, and the parts affected will show
signs o f strain, at first, perhaps, vague but nevertheless severe in
their cumulative effect. When slight and merely annoying in char­
acter, the signs seem plausibly to indicate deranged physiology due
to poor body mechanics. When severe, however, they may seem out
o f all proportion to the defect in posture that is the apparent cause.
Then only a most thorough and searching examination, to rule out
other factors as possible causes o f the complaints, can determine their
origin. I f such an examination by an internist or a pediatrist re­
veals no organic explanation, then and only then should these symp­
toms be attributed to poor posture.
Backache may be due specifically to poor posture. Strain o f the
supporting muscles and ligaments of the spine from maintaining the
erect attitude in a position o f mechanical disadvantage eventually
may result in pain. But other affections o f the spine—for instance,
tuberculosis, the so-called arthritic processes, and other organic
lesions, abdominal or pelvic—must first be ruled out as causative
factors. Backache in the middorsal region between the shoulder
blades or at the “ small of the back ” in the lumbosacral region, and
many “ headaches ” at the base of the skull may be relieved by bal­
ancing the entire spine in its position of normal curvature.
Constipation also may be due specifically to poor posture. With
incorrect body mechanics the relaxed protuberant abdominal wall
does not support the stomach and intestines adequately. Ptosis and
then partial stasis in the gastrointestinal tract may follow. How­
ever, obstructions due to some chronic organic lesion, subacute in­
flammatory processes, atonic and congenital conditions o f the intes­
tines, and incorrect dietary and other habits must first be ruled out
as causes. Correcting the posture can raise the abdominal viscera
from 1 to 5 inches, to the highest position for these organs for the
given individual. Abdominal muscle contraction, such as is neces­
sary for good posture, will generally accomplish this most effectively
in subjects with lax abdominal walls.
Abdominal pain, chest pain, and pain in the limbs may sometimes
be due specifically to poor posture. The attitude with exaggerated
spinal curves may produce signs of pressure on the dorsal roots o f
the spinal nerves with segmental distribution of pain along the route
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o f the branch nerves.4 Here again, however, appendicitis, tabes mesenterica, herpes zoster, pleurisy, bursitis, varicose veins, tabes dorsalis,
and many other organic conditions must first be eliminated as cti0logical factors. Correcting the posture will relieve pressure on the
nerve roots as they emerge from the vertebral foramina, and will be
followed by a cessation o f symptoms if there is no organic difficulty.
In many cases where no active disease is present dysmenorrhea
may be attributed directly to poor body mechanics with its asso­
ciated ptosis and displacement o f viscera. The uterus is crowded
out o f position, and the free circulation o f blood through it is in­
terfered with. The supporting ligaments become lax. General body
fatigue is present. The result may very well be a discomfort inten­
sified at the period of menstruation. I f by means o f posture tram-»
ing the lower abdominal wall is retracted the abdominal viscera may
be elevated, and the uterus and its adnexa, relieved o f pressure from
superincumbent abdominal organs, may function normally.
Insomnia, poor or capricious appetite, and u general disability
or neurasthenia may be due indirectly to poor posture with its waste
o f the available energy of the individual and the consequent bodily
fatigue. On extreme physical fatigue nervous or mental irritability
may supervene and manifest itself in insomnia, poor appetite, or
neurasthenia. But these symptoms also may be due to organic causes
which should be eliminated as etiological possibilities before hope
is extended to the sufferers from these complaints that they will be
relieved by improving their body carriage.
. .
Malnutrition, the petit-mal form o f epilepsy, and cyclic vomiting
are conditions often improved by correcting body posture. Here
again posture training is the method o f relief only after all other
factors have been eliminated or in connection with treatment for
other causes. When the patient has learned to use his body economi­
cally he will suffer less from gastrointestinal stasis and fatigue,
which are possible causes o f these complaints.
.J ^ _ ■
In the physical conditions just discussed correction o f the body
mechanics will afford relief so far as the symptoms may be directly
or indirectly referable to disturbed physiology. It must be empha­
sized that good posture is not a panacea. Thus, it would be absurd
for a patient vomiting periodically because o f a stomach lesion to
hope for relief with postural training; just so with neurasthenia
from goiter, constipation from megalocolon, or bachache from early
Pott’s disease. Only when no organic cause can be found to explain
the symptoms should poor posture be considered as the important
etiological factor. Sometimes, however, even when other factors are
known to be present, if poor posture is associated with them the gen­
eral condition o f the patient may be improved by improving the pos­
ture and so increasing the reserve energy with which to combat the
other factors.

Persons with complaints deferable to disturbed physiology due
to poor body mechanics may be relieved of their complaints by the
4 Danforth, Murray S.f M. D „ and Philip D.. Wilson M D .: “ The « t o m y of the
lumbo-sacral region in relation to sciatica pain.
The Journal of Bone and Joint
Surgery [Boston], Vol. V, No. 1 (January, 1925), pp. 109 160.
Federal Reserve Bank of St. Louis



habitual assumption o f a good body carriage. For the purposes o f
this report discussion o f methods o f treatment will be limited to
treatment for children 5 to 15 years o f age, though older persons
may profit by a similar routine.
The logical site for a posture clinic is the out-patient department
or dispensary o f a general hospital. Here patients with physical
complaints naturally come for treatment. Since posture training
should not be given in the hope o f relieving symptoms until all
etiological factors other than poor body mechanics have been elimi­
nated, it is advantageous to have easily available the adequate
hospital facilities for general physical examination and special study
to eliminate such other factors.
• Patients should be accepted in the posture clinic only when re­
ferred to it from other departments o f the dispensary. As a routine
procedure consultations should be had with all other departments
treating given symptoms. When these departments have ruled out
the possibility o f organic cause for the trouble and are satisfied that
disturbed function o f body parts is due to the poor position o f those
parts, the patient should be enrolled in the posture clinic. This
clinic will function as a correlating agency. Thus, i f a child is sent
to the posture clinic from the orthopedic clinic because o f “ round
shoulders and a forward head ” a consultation will first be held with
the pediatrist, who will make a complete physical examination and
advise with regard to further consultation as, for instance, with
the opthalmologist to eliminate eye trouble as a cause for the forward
WTiere a hospital location is not available a clinic will function
well if established by a visiting-nurse association in conjunction
with child-health centers. Patients will be referred from the neighbormg schools by the school nurses and from the district by local
physicians. Many cases will be referred from the conferences o f
the visiting nurse association personnel. Many cases will come
directly from the home as a result o f cures reported fr o m parent to
parent. But here again the child must first be examined by a pedia­
trician and an orthopedist. Before corrective posture training is
begun the etiology o f the trouble must be diagnosed as poor body
mechanics. To this end consultations should be held with medical
men on the staff o f the nursing association or o f some near-bv hos­
When the child is accepted for training the regular organization
o f the visiting-nurse association can be used very effectively. The
nurses make admirable teachers o f good posture in the clinic. They
also have the knowledge o f medical matters that is essential fo r
productive home visiting in cases o f the type treated in the clinic.
. Once the child is enrolled in the posture clinic and is started on
its routine procedure he is best cared for i f an orthopedist and a
pediatnst assume joint responsibility for his medical care.
Tne following are among the kinds o f cases referred to the posture
clime o f the Massachusetts General Hospital from various depart­
ments o f the institution: Cases o f malnutrition, cyclic vomiting,
petit-mal epilepsy, enuresis, constipation, poor appetite, and ortho­
static albuminuria from the children’s clinic; cases o f backache and
postural curvatures o f the spine from the orthopedic department;
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and cases o f dysmenorrhea from the genitourinary department, of
abdominal and chest pain from the medical and surgical depart­
ments, and o f general debility and neurasthenia from thie medical
and neurological departments.



The posture clinic, as has been stated, is logically situated in an
out-patient or dispensary section o f a hospital, or at a child-health
center, because it is then located at the source o f its greatest supply
o f patients. The hospital clinic affords opportunity for treatment o f
those with symptoms o f illness due to poor body mechanics. The
health-unit clinic, on the other hand, furnishes its quota o f those who
are usually not ill enough to go to a hospital for treatment. These
patients may have in milder form the very same type o f symptoms
as the patients who go to the hospital clinics for relief.
The clinic should be on an upper floor i f possible. Since much o f
the work is done with the children lying on the floor, it is advisable
to move the clinic as far as possible away from drafts, especially o f
cold air. Moreover, it is easier to keep the child quiet and restful
when he is at a distance from the rest o f the busy hospital or healthunit activities. The clinic workers can then read to the children
or entertain them otherwise while they are resting undisturbed. The
maximum amounts o f sunlight and ventilation in the clinic room are
o f course essential.

The equipment needed for the clinic should include a pad for each
child to rest on. This should be a cylinder about 18 inches long and
about 12 inches in circumference. It can be made of rolls o f news­
paper, excelsior, or some such material covered with cloth to make a
little bolster.
A camera or schematograph with which to make photographs or
tracings o f the body form is also essential. Cameras taking pro­
file pictures directly on bromide paper are for sale. I f such a camera
is not available a profile tracing can be made with a schematograph
like the one sold by the American Posture League. The writer has
used a schematograph made by salvaging an old square-cased camera,
which cost about $6 and some spare moments. The lens was left
as found. Directly back o f it, however, in the film chamber was put
an ordinary mirror facing the aperture back o f the lens and fixed at
an angle o f 45° to the bottom o f the case. The top o f the film
chamber was removed and replaced by a piece o f glass. When an
undressed patient was placed in front o f the camera, with the side
o f his body toward the lens and with lights shining in back and
in front o f him a piece o f tissue paper placed on the new glass top
o f the camera would show the image o f the patient as reflected by
the mirror below. The contour o f the image when traced on the
paper would give a graphic record o f the body contour o f the indi­
vidual before the camera. A tracing o f this record as a pattern on
black paper and then cut fom the black paper on the outline would
give as a final result a black silhouette.
An ordinary balance scale o f the type usually found in hospitals
is adequate for weighing the children. For measuring their height
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a wooden measuring rod attached securely and accurately to ,the
wall should be used. When the child stands against it the base o f
a “ right-angle” bracket on the top of the head and against the
measuring rod will indicate the child’s height.
I f the body measurements are to be kept the only equipment neces­
sary is an ordinary pelvimeter or calipers of the type used by ob­
stetricians, a tape measure preferably o f steel, and a device for
measuring the angle formed by the lower ribs at their junction with
the xyphoid cartilage. For this last instrument the writer used two
pieces o f steel united at one end by a hinge joint and opening sidewise on a protractor. The protractor allows for a reading, in de­
grees, o f the size o f the angle formed by the sidewise opening of the
two steel arms o f the instrument, and since these arms are placed
against the angle formed by the lower rib borders the reading on
the protractor is the angle o f the ribs— the intercostal angle.
A mirror large enough to show the whole body o f the child is a
great help in teaching the child correct posture. As is shown in
the description o f exercises (see p. 28) posture is taught with the
child standing up, first against a wall and later away from the wall.
Then i f the child stands with the side o f his body toward the mirror
he can see the defects in his body posture and can correct them more

The personnel of the clinic should include an orthopedic surgeon
in nominal charge, the examiner and consultant in all problems; one
worker in actual charge o f the clinic; other workers to teach good
posture (at least 1 worker for every 10 patients); and if possible a
volunteer secretary. I f it is impossible to get secretarial service
gratis, the work could be divided among the other members o f the
staff. The best clinic workers are nurses with a background knowl­
edge o f orthopedic nursing and special training in posture work.
O f course temperament and personality fitted for work with children
are a fundamental requirement. Nurses seem to fit better into clinics
than do graduate physical educators because of their knowledge of
medical problems and procedure.
Time spent by children in the clinic.

The clinics should be held not less than twice a week and prefer­
ably three times. Each session should last generally from one to
one and one-half hours. Each child after resting for 20 to 30 minutes
should receive 10 to 15 minutes of intensive instruction. While the
child is resting a volunteer or one of the staff may read to him or
tell him a story. The child will then relax more completely. At the
end of his rest period he should receive at first about 5 minutes of
individual instruction. Then, with a knowledge o f how to do the
fundamentals of postural training, he may be grouped with a few
others for more or less advanced instruction, requiring about 10
minutes more. Thus, a child will spend only about 35 minutes twice
or three times a week in the clinic in learning good body mechanics.
He will therefore have to practice at home and repeat at least three
times a day all that he has done in the clinic.
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F I G S . 11 A N D 12.— P R O F I L E S I L H O U E T T E S O F T H E B O D Y F O R M A T T H E
F I G . 13.— P A S S I V E P E C T O R A L S T R E T C H I N G E X E R C I S E
F I G . 14.— C H I L D IN R E S T I N G P O S I T I O N
F I G . 15.— C H E S T E X P A N S I O N W I T H D E E P I N S P I R A T I O N
F I G . 16.— M A N U A L " C O A C H I N G " T O I N C R E A S E C H E S T E X P A N S I O N
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Children who will receive greatest benefit.

Posture instruction in clinics may be expected to benefit most
strikingly children, especially girls, between the ages o f 7 and 10.
The child is then in his most receptive and pliable stage. He has
what is very important in posture work—power to coordinate mind
and body. His ability to coordinate, and a serious willingness to
learn and to cooperate at an age when body defects have not yet be­
come fixed are the characteristics that warrant speedy benefits from
postural training for children of 7 to 10. They will be relieved most
readily from complaints due directly to poor body mechanics, espe­
cially backache and constipation. O f course, all children o f ages
that can be taught good posture will be expected to derive some bene­
fit from the training in the correct use of the body, and this benefit
will be in direct proportion to the children’s power to coordinate and
willingness to cooperate.
Attendance of mothers at clinic.

Since most o f the time spent in learning to use the body well will
have to be time out o f the clinic and under the parents’ supervision,
the more the parents know about the subject the more they will stimu­
late the children to acquire and maintain good posture. Mothers
should be urged to attend the clinic with the children once a month.
When at the clinic the mothers should be close to the children to see
just what they will have to repeat at home, and to receive explana­
tions. At the same time instruction and advice can be given them
as to diet and other contributing causes of their children’s complaints.
Home visits.

To make sure , that the child does repeat at home what he has
been taught, follow-up visits should be made to his home. A
nurse trained in family-welfare work is ideal, and social-service
workers are, o f course, also good for this kind o f work. During
the home visits instructions can be repeated, difficulties that may
have cropped out can be eliminated or minimized, and those who
are concerned for the well-being o f the child can be kept inter­
ested in his work. The effect o f these visits will invariably be
to increase cooperation and thus shorten the time necessary for
correcting the child’s posture and forming the habit of good body
The workers at the clinic and the home visitors should be able
to impress on the children and their parents what benefits may be
expected if the children use their bodies correctly and what pen­
alties they may be called upon to pay if they do not. Workers
should be familiar with the exercises, the manner o f doing them,
and the reasons for doing them. The fundamentals especially
should be clearly understood. In fact, only after much thought on
the subject o f body mechanics will the workers’ ideas become crys­
tallized, but they must be crystallized and ready for logical and
quick presentation to the children and their parents.
The worker will create an unconscious feeling o f sympathy, the
sine qua non in this sort o f work, if she will put herself in place
o f the mother she is visiting. Before she makes her visits she
should acquaint herself with the history o f the family and decide
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what motive to concentrate on for appeal. Thus if the children
are undernourished or pretubercular an appeal for regular attend­
ance or home cooperation should be based on the children’s needs
in relation to these physical conditions. The parent may say that
the poor child has too little time outside school, elocution, music,
¿Hid other lessons to devote time to posture training* The worker
should then show why the clinic is important for the child, finally
stressing the reason that seems to arouse the greatest interest. The
gains o f some child in the neighborhood who attends the posture
clinic and who is conscientious and cooperating may be described.
Perhaps it is pride in the appearance of the child that appeals to
the mother. I f so, she may be shown a picture o f Queen Louise, in
which the points o f good body mechanics can easily be demonstrated.
The fact that Queen Louise could not be beautiful if she stood
poorly should be stressed. Perhaps the child is undernourished,
and the visitor may appeal to the mother’s affection by expressing
her own interest in improving the child’s condition and perhaps
showing the mother some weight curves indicating the weight
gained by children with malnutrition who have been taught body
mechanics. Attention can be centered on changes in posture in
children instructed for one season. The improvements can be noted
and the values stressed on a physiological and health basis. This
visual appeal by graphic curves and figures is usually most effective
m transforming the interest o f the parents into a desire to see that
their children avail themselves o f the privilege o f learning how the
body should be used.
I f the child is interested in athletics he may be shown the picture
o f an athlete finishing a race. The child should be reminded that
this posture was taken because the athlete had learned that if his
body is thus used his speed and endurance are increased. Workers
should show pictures o f Washington, Lincoln, and other men of
achievement with strikingly good body mechanics. Posture, good
or bad, seems to have a mental effect upon the individual which
affects, favorably or unfavorably, his capacity to achieve.
O f course, some children will have to be almost dragged to the
clinic for instruction in posture. But if the workers are persistent
in visiting the home and tactful in stressing the motives that make
the strongest appeal to both parents and children they will influence
the family toward complete cooperation. The necessity for regular
attendance at classes and continuous cooperation in the intervals
between classes should be emphasized.
Workers, however, will foster the desire for the acquisition o f
good body carriage only if they themselves believe in its importance.
I f they are not interested they should not undertake family visits.
They can not imbue others with a spirit that is lacking in themselves.
Theirs is missionary work in preventive medicine, for correcting
body mechanics is one important way to increase the body’s resist­
ance to disease. I f they are interested they will learn the subject
matter o f body mechanics. Then, with thorough confidence in the
value o f the subject, they will spread the gospel of health and
grace from better mechanical use o f the body. Above all they
must attain correct posture themselves. Their own example will
gain as many converts as their words.
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A ll children enrolled in posture clinics should first be questioned
thoroughly by the nurse in charge as to their habit histories. The
amount o f sleep, the time spent outdoors, dietary and other health
habits (see the form at end o f report) should be investigated.
It is the purpose o f the clinic to teach the child one o f the habits most
effective for health— that o f good body carriage. It should also see
that the child’s other habits upon which proper physiology greatly
depends, are also good—fit company for good body mechanics. A f ­

ter study has been made o f the child’s likes and dislikes for different
foods and o f his habits as to times for eating, regularity o f meals
is urged. A list o f proper foods is furnished from which his mother
may choose sensible meals. Emphasis is placed on the child’s hav­
ing the amount o f sleep deemed sufficient for his age by most au­
thorities. Above all he is instructed— and this point is stressed—
to take rest periods after each meal flat on his back on the floor with
a pad under his shoulder blades. A t no time should he use pillows
under his head. The effort is to straighten his spine; pillows would
only serve to exaggerate the normal curves at one end.
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A history o f the child’s illnesses previous to entrance into the
posture class, on comparison with a similar later history, will indi­
cate the effect o f posture on his resistance to infectious diseases.
It is assumed that the child has no infectious disease nor organic
cause for his trouble when admitted to the posture clinic. This will
have been ascertained before his admittance by a routine pediatric ex­
amination by the pediatrician in attendance at the posture clinic or
the consulting pediatrician in the children’s clinic.
Once the child is enrolled, his standing and sitting height in his
“ stocking feet ” are taken. Then his weight while wearing ordinary
indoor clothing is recorded. These data furnish the clinic worker,
with the help o f W ood’s table o f average weights for children o f
given sexes, heights, and ages, with an idea o f the average weight
for a child comparable with the patient. The weights are recorded
weekly on plotting paper, and the points are joined to form a weight
curve. These curves are always conspicuously displayed on the walls
in the clinic. The children naturally vie with one another in fol­
lowing directions, hoping to increase their weight. The value o f
stimulating such ambition, especially in undernourished children,
need hardly be stressed when the importance o f good body nutrition
is so generally recognized.
A profile silhouette (figs. 11 and 12, facing p. 18) o f the body form
may be made with a camera directly on bromide paper. I f such a
camera5 is not available a profile tracing (fig. IT) is taken with a
schematograph (see p. 21). These silhouettes are posted on a card
hung on the wall, so that the children may note their own progress
and thereby be stimulated to more energetic work.
After this preliminary work the child should be examined by the
orthopedist in attendance at the clinic. First he is classified with
reference to his body form as thin, broad, or intermediate, and then
he is graded A , B, C, or D on his posture, according to the standards
o f classification and grading given on pages 5-13. Deformities
o f the chest or spine and static deformities o f the lower limb are
then recorded. The part o f the trunk where the movements o f
respiration are featured is recorded; attention is drawn either to the
abdomen where the excursion o f the diaphragm is the chief feature
o f respiration or to the ribs when elevated in the costal type o f respir­
ation. Finally, with anthropometric measurements such as the girth
o f the abdomen and chest at different levels and the angle formed by
the lower borders of the ribs with the lower end o f the sternum the
examination o f the child is completed.

First the child lies supine on the floor, over a pad laid crosswise
under the back, at the level o f the lower angle o f the shoulder blades
(fig. 14, facing p. 18). He should draw his chin in as i f to “ make
a double chin.” The arms should be extended above the head to
open up the spaces between the ribs. This position is assumed beB Fradd, N. W .: “ A new method of recording posture.”
Joint Surgery, Vol. V, No. 4 (October, 1923), pp. 757-758.
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The Journal of Bone and



cause it relaxes the muscles and ligaments usually contracted m
maintaining the body in incorrect posture. The pad under the
shoulder blades elevates the chest and tends to straighten the spine,
forcing the trunk to the A position. Thus the child rests with ms
body in its best position. Twenty to thirty minutes is usually neces­
sary to get complete relaxation before any attempt is made at cor­
rection o f the poor posture. Without this relaxation over a pad cor­
rection is much more difficult. The best time for the rest period is
after each meal. Then the child benefits not only from getting the
relaxation needed for the corrective exercises but also from getting
rest during the period o f digestion.
After the rest period the pad is removed, and exercises are given
to the child lying supine on the floor with knees slightly flexed.
Corrective posture exercises.

Exercise / . —Lying on the floor the child flattens the lower back by
rolling the pelvis, i. e., contracts the buttock muscles and retracts
the abdominal muscles and so rolls the hip about the hip joint as a
pivot (fig. 18 A and B ). In doing this he may keep one hand

on the lower abdomen while he uses the other to feel the flattening
o f the spine against the floor. In this way the child learns to roll
the pelvis and to decrease the exaggerated curves o f the spine, with
the help of gravity.
. , n
Exercise I I .—Lying with back flattened against floor (as de­
scribed in Exercise I ) the child does deep breathing.
While expanding the ribs in inspiration (fig. 15,^facing p. 1?;
the child may grasp the ribs (fig. 16, facing p. 18) where they
form an angle with the lower end o f the sternum (breastbone) and
may pull on them upward and outward to coach the thoracic
muscles that cause the outward and upward movement o f the ribs
in inspiration. Then, since expiration is fundamentally passm , let
the child exhale without “ coaching manually. Let him keep on
exhaling to the point o f complete expiration. This is aided by the
contraction o f the abdominal muscles.
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This exercise increases the girth of the chest, enlarges the lungs
through the thoracic movements, and tends to mobilize the dorsal
spine and to render it more flexible for flattening.
Exercise / / / . —Lying with back flattened against the floor (as
described in Exercise I ) the child alternately raises the arms slowly

F ig. 19.

Alternate arm raising while good posture is maintained in the supine position

over the head (fig. 19). This accustoms the child to using the arms
without changing the position of the back—all with the help o f
Exercise IV .—Lying with back flattened against floor (as described
in Exercise I ) the child bends knees back over the abdomen. He
then grasps one knee with both hands and holds that knee bent

F ig . 20.— Straight leg exercise with one thigh flexed on the abdomen

with the thigh on the abdomen. This keeps the back flat. He ex­
tends the other leg straight up from the abdomen and slowly and
gradually lowers it to the floor (fig. 20). Then he returns both
legs to the starting position and repeats the exercise, alternating
the legs.
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Through this exercise the child gets the “ feel ” o f keeping the back
flat while a leg is being used— and this with the help of gravity and
one flexed thigii. The exercise also tends to loosen tightened muscles
and ligaments which may prevent full range o f motion in the
joints— as, for instance, tightened ham strings about the knee.
Exercise V .—Lying with back flattened against the floor (as de­
scribed in Exercise I ) the child raises one leg to an extended posi­
tion at right angles to the torso and then slowly and gradually low­
ers it to the floor. Then after returning the legs to starting position
he repeats the exercise, alternating them.
This exercise develops the abdominal muscles and the ability to
keep the back flattened while using the legs.
Exercise V I.—Lying with back flattened against floor (as de­
scribed in Exercise I ) the child raises both legs to an extended po-

the feet to the floor.
This exercise accentuates the development o f the abdominal mus­
cles and the ability to keep the back flattened while using the legs.
The foregoing exercises should be continued until the child can
flatten his back against the floor fairly well. Then the following
o-^up o f exercises should be taken in the standing position:
*/yExercise V II.— Standing with his heels 4 or 5 inches from the
wall and with his buttocks, shoulders, and head against the wall
the child flattens his back against the wall by contracting the buttock
muscles and by pulling in the lower abdominal muscles 5 i. e.5 by
rolling the hips on the hip joint as a pivot (fig. 22 A and B ).
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F ig. 22.— Retraction of the abdominal muscles and contraction of the buttock muscles to
assume correct posture against the wall
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I f the child will imagine that he has a tail on the end o f the spine
and will try to touch the floor with the tail without bending the
knees, he will grasp the idea o f rolling the pelvis and will get the
“ feel ” o f flattening his lower back and o f standing erect without
the help o f gravity. I f the child is taught to aim for a flat back
he will attain the back desired, one with normal curves. Thus to get
the proper position, as shown in Figure 23, A, B, C, the child first

rests the upper back and buttocks against the wall, then flattens
the lower back, and finally pulls the head back and the chin in,
raising the chest into its proper position.
Exercise V III.— Standing with back flattened against wall (as
in Exercise V I I ) the child places his hands against wall and with
flexion only at the ankle joints comes away from the wall with the
body held in the same position as at the start o f the exercise. Then
while holding this position he should walk forward (fig. 24, A ,B , C ).
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When he can hold position while walking forward let him try to
return and still maintain correct body alignment. I t is difficult
at first to turn around and still keep the correct position. The
abdomen, for instance, is held retracted consciously, and when some
action like turning around is attempted the conscious control is lost
while the mind is busy with the turning.
Exercise I X .— Standing away from the wall with back flattened
and chin in, the child bends the trunk forward at the hips (fig. 25
A and B ). This exercise may be made more difficult by clasping
the hands on the top o f the head when starting the exercise. ' Either

F ig. 24.— Method of walking away from the wall after correct posture has been attained

way it accustoms the child to maintain a good position and to keep
the rib spaces open even while bending forward.
Exercise X .— Standing awajr from the wall with back flattened
and chin in, the child rises on his toes and stretches his arms upward
and forward to form an angle o f 45° with the axis o f his head and
neck, and at the same time inhales deeply. Then he lowers his
arms and comes down on his heels again while exhaling. This
exercise teaches flattening o f the spine while the mind is busy with:
breathing and balancing the body.
Exercise X I .— Standing away from the wall with back flattened
and chin held in (the chin must be in so that the ribs will be held
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elevated) the child breathes deeply. The hands may be kept clasped
on the head or on the lower rib borders to offer resistance there.
This resistance facilitates the acquisition o f control over the rib
This exercise tends to strengthen the diaphragm and to teach the
child diaphragmatic breathing (fig. 26, A , B, C ). Such breathing
increases the circumference o f the lower thoracic cavity following
the descent o f the normally dome-shaped diaphragm. The upper
abdomen in this exercise is the part o f the trunk strikingly mobile
with respiration.
Exercise X I I .— Standing with as good posture as possible the
child faces a corner o f the room and places one hand, palm flat and
thumbs down, against each wall at shoulder height. W ith his arms

F ig. 25.— Trunk forward bending exercise

held at an angle o f about 90° at the elbows and wrists and with
upper arms raised to shoulder level he rises on his toes and sways
forward with flexion only at the elbows, maintaining at all times
the good posture o f the start (fig. 27, p. 31). He should not “ hollow ”
the back, drop the head and chin forward, nor drop the abdomen
downward. The child returns to starting position and repeats.
A marked strain should be felt on the pectoral group o f muscles,
the degree depending on the amount o f tightening o f these muscles.
I f this exercise does not stretch the tightened pectoral muscles where
the shoulders are o f the exaggerated forward type (the very ro'und
shoulders) the following exercise should be used:
Exercise X I I I .— Sitting in good position, the child raises his arms
to his shoulders and clasps his hands behind his neck. The assistant
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then should put her knee against the child’s back at the region o f the
apex o f the dorsal convexity, and when the child has reached deepest
inspiration she levers the child’s arms back toward herself on her
knee as a fulcrum (fig. 13, facing p. 18).
W ays to interest the children.

Through these exercises a child will first learn, with the help of
gravity, to attain proper carriage o f the body while lying on the
floor. Then standing against the wall he can get the feeling o f
correct posture in the erect position. This is followed, after suffi­
cient practice and exercise, by ability to walk with good body me­
chanics. A ll this can be expedited, after a certain amount o f pre­
liminary instruction, by having the children put one another through




F ig. 26.— Diaphragmatic breathing exercise. A. Starting position. B. Inspiration. (Note
how the lower ribs move outward at the sides.) C. Note excursion of the upper ab­
dominal wall with this type of breathing

the exercises. They naturally learn much more quickly while teach­
ing and correcting the faults of others. The interest in and respon­
sibility for a “ neighbor’s ” and also one’s own posture under these
conditions is remarkable and most encouraging. It is perhaps the
pleasantest way o f practicing good body posture. Children who
have learned the fundamentals may be grouped to do the foregoing
exercises or any form o f “ setting-up drill.” They become extremely
interested in the work if a different child each day gives the orders
while another walks through the group and helps the “ instructor ”
to see that his orders are obeyed accurately. In this way what the
children know about posture becomes crystallized in their own minds.
I f the children are given as much insight as possible into the
fundamentals of good posture they will become more interested
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in practicing at home what they learn in the clinic. Skeleton draw­
ings (figs. 1 and 2, p. 3), tracings, photographs, and illustrations
of the exercises can be used as aids in teaching body mechanics to
the child. He can learn what the indexes of good and bad posture
are and analyze his body defects and the needs for correction in his
own case and in that o f his neighbors in the clinic. Then he will
want to correct his own posture and to do so before his neighbor
does. This spirit o f competition can be stimulated through the use
o f charts showing the tracings and grades for all the children. The
more the child knows of posture the
harder he will try to attain good
“ Natural ” body carriage the result of
continuous practice.

At this stage in the acquisition of
good body mechanics the posture,
though perhaps correct, will usually
be stiff and awkward looking. Con­
tinuous practice until good body
mechanics becomes habitual is the
only means o f rendering it easy and
graceful. Practice in maintaining
good form while doing common
everyday things, such as sitting,
tying shoe strings, picking up ob­
jects from the floor, reaching for
things, will also hasten the acquisi­
tion o f natural, graceful, and effi­
cient body mechanics and poise.
Time required




The time necessary to acquire
habitual good body mechanics varies
with different individuals. The de­
termining factor is the child’s abil­
ity to control the muscles o f his body F ig . 27.— Active pectoral stretching ex­
and to keep them in balance. With
initial conscious effort and with per­
severance one can learn to use his body subconsciously with mechani­
cal efficiency, grace, and rhythm and with the least waste o f energy,
but first must come conscious control of groups of muscles essential to
the maintenance o f perfect balance. Good habits must replace bad
habits until the former become instinctive. The poise which has
become essential to the perfect functioning o f the complicated ma­
chine, the human body, must be reestablished and maintained with­
out effort as it is in the normal young child.

The average man’s posture, because o f various influences, has
become drooped or ptotic. This is often followed by conditions con­
sidered capable o f being explained as deranged physiology due to
poor body mechanics.
Federal Reserve Bank of St. Louis



When these manifestations can be interpreted as being due directly
or indirectly to such poor posture they can be eliminated by teaching
the child how to use his body correctly. In posture clinics children
with symptoms apparently without organic cause and referable in
some way to poor posture can be relieved by learning the funda­
mentals o f good body mechanics.
The posture clinic is best located in connection with a hospital
dispensary, where pediatric and orthopedic clinics may serve as
referring agencies; or in conjunction with clinics maintained by
visiting-nurse associations or by child-health centers. The posture
clinic should cooperate with the various departments o f the hospital
dispensary and also with health centers, conferences, and schools.
The equipment necessary for the posture clinic is very unpre­
tentious and inexpensive. It consists o f a large room, a roll or pad
for each child, a camera or schematograph, a weighing scale, an
apparatus for measuring height, a pelvimeter, a tape measure, an
anglemeter for measuring the angle between the lower rib borders,
and a long mirror.
The personnel o f the clinic should include an orthopedic surgeon
and a pediatrist if no pediatric dispensary is available. There
should be an instructor or worker for every 10 patients. The workers
may be nurses or physiotherapists. The clinic should also have a
worker who can do follow-up work judiciously and sympathetically.
Clinics for instruction should be held at least twice a week. It
is supposed that each child will first have had a physical examination
by a pediatrist and then by an orthopedist. The latter will classify
the child according to physique, grade him according to his posture,
and then prescribe the instruction.
First the child must be shown good posture. The indexes o f good
and poor body mechanics are impressed on his mind. He is in­
structed in the conscious maintenance of good body carriage with
the help o f gravity and then without it. Finally, with continuous
practice, his carriage should become habitually graceful and easy
without conscious effort.
Good posture, however, will come only after continued effort and
close cooperation on the part o f the child, the parents, and the clinic
workers. The clinic staff must strive continuously to effect this
cooperation by an attitude o f encouragement and approval toward
the child and an attitude o f interest and understanding toward the

Federal Reserve Bank of St. Louis

C . B. 83
C h il d b e n ’s B



Field No .
S ex , M. F.


Date of Birth

Race, W . B . N . F . O . (S pec.)


O ffice No .



(6) Nap, N.






(6) Nap, N.



14. Foods liked. ____________________



Bread, N., Cereal, IS
Meat, N., Eggs, N., Pot., N -- Meat, N., Eggs, N., Pot., N ._ Meat, N., Eggs, N., Pot., N ._
Greens, N., oth. veg , N
Milk, N., Butter, N

Coffee, N . . . ....................
6. Infectious diseases (specify)________ Yes, N o _______________________ Yes, N o _______________________ Yes, N o . . . . . . . _______
Yes, N o ....................... ..
Yes, N o ........................

Y ak ,


Y p.s ,

Nn _





Yes, N o ........................ Yes, N o .......................................... Yes, N o _______________________
Yes, No

— .....................................

17. Height_____________________________
18. Weight_____________________________

... %

19. Underweight_________________ _

21. Color skin, memb




A B C D ..............






— ...............

22. Eyes, normal (spec.)_________

(6) Noon, Hr_____________________ Food..
Y ak ,

Nil _

Prnh., Nn, Rem

26. Nasal discharge________________
Enl., N., Dis., N., Rem. N —

Enl., N., Dis., N., Rem. N ____ Enl., N., Dis., N., Rem. N .._

28. Other. ..............................

(d) Other, Hr___________ Food..

30. Teeth: (a) No. lost........ .
(c) Clean___________ ______ Yes, Nn .

12. Appetite___________________

Yes, No..................

Y ak , N n

(/) Malocclusion....... .............. Yes, N n _____________

13. Digestive upsets.......................

Y ak , N n

(g) Other.... .................. ........

Federal Reserve Bank of St. Louis

5795— 26.

(Follow J>. 32.)


Glands: 31. Occipital .




G. Enl.



G; Enl.



G. Enl.





50. Pronation........................
51. Abduction_____________

32. Submaxillary_______________
.34. Arill ary____________________

52. Breathing..___ ________

Cos. Up. Abd., Low. Abd___ Cos. Up. Abd., Low. Abd___

53. Retraction_____________

Costal, Abdominal_________

Cos. Up. Abd., Low. Abd___

Costal, Abdominal................ Costal, Abdominal_________


35. Epitrochlear___ ____ ________

54. Abdomen at navel______

36. Inguinal___________________
37. Thyroid enlarged___ ______

■Yes, N 0......................

Yes, N 0......................... Yes, N

38. Signs hyperthyroid (specify)__ Yes, N 0.....................— Yes, N 0..........-.............. Yes, N

(c) Expiration____ ____
56. Xyphoid:

39. Heart (spec. abn.)—— ! _____



(b) Inspiration________

Nor., Abn...... .............. Nor., Abn...... ............. . Nor., Abn____ _______

(c) Expiration____ ____

40. Lungs (spec, abn.)___________ Nor., Abn_______ __ Nor., Abn___________

Nor., Abn____ _______

(6) Inspiration________
(c) Expiration________
58. Abdomen: (a) Normal___

41. Abdomen (spec, abn.) _______ Nor., Abn................. .

42. Hernia (specify)_____________ Yes, No____________

Nor., Abn____________ Nor., Abn____________

(b) Retracted............

61. Tracings_______________
62. Examined by____ - - - - - - -

Nor., Abn___________

44. Type___ __________________

Thin, Nor., Broad____

45'. Standing position____________ A B C D____________

------------------------------------ in.

59. B readth of chest at
60. Vital capacity___ ____

Yes, No........................ Yes, No— .....................

' 43. Reflexes (spec, abn.)_____ ____ Nor., Abn_______ ____ Nor., Abn____ _______

........ ................................ in.


Thin, Nor., Broad_____ Thin, Nor., Broad_____
A B C D____________

A B C D_____________

Nor., Abn..................... Nor., Abn___________

Nor., Abn......................

Nor., Abn..................... Nor., Abn___________

Nor., Abn...... ...............

46. Shape chest..______ - _______
(spec, abn.)___ _____________
47. Scapulae (spec, abn.)________


—— ------------------------

48. Spine (spec. abn.)--. ________ Nor., Abn___ ________ Nor., Abn..................... Nor., A bn......... ...........
49. Other abnormality (specify)___ Yes, Nc

Yes, No

Yes, No

Federal Reserve Bank of St. Louis

5795— 26.

(Follow p. 32.)