View original document

The full text on this page is automatically extracted from the file linked above and may contain errors and inconsistencies.

UNITED STATES DEPARTMENT OF LABOR
W . N. DOAK, Secretary

C H IL D R E N ’ S B U R E A U
GRACE ABBOTT, Chief

POSTURE
AND PHYSICAL FITNESS
O'
By
ARMIN KLEIN, M. D.
AN D

LEAH C. THOMAS

Bureau Publication N o. 205

¿ 2 ..7
UNITED STATES
GOVERNM ENT PR IN TIN G OFFICE
WASHINGTON : 1931

For sale by the Superintendent o f Documents, Washington, D. C.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Price 10 cents


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

CONTENTS
Page

Letter of transmittal_______ _________________ 1_________
The problem and the group______________________ I I I I I
I I ""
Procedure of study of each child________ _________I I I I _ I I I I I _ I I
The posture of the selected group before training_______________
The improvement shown in posture after training________ I_II_
Posture and nutritional condition__________________________
The relation of posture to school work______________I ___ 1112111
Physical indexes of the results of posture training______________I
Vital capacity____________________________
Type of respiration_____________________________ I I I I _ I I I I
Posture and costal mobility________________________________
Type of retraction-____________________________________ ~~
Circumference and depth of abdomen_____ ________________
Breadth of chest___________________________________
The costal angle______________________________
Biacromial depth___________________________ III__I_
Posture and pronation_________________________I I _ I _ _ I ”
Scoliosis_____________________________
Summary______________________ _______
Appendix— Physical-examination schedule used" in posture study

v
1

5
15
18
23
28
30
30
30
32
33
36
37
38
39
39
40
41
44
m


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

LETTER OF TRANSMITTAL

U n it e d S t a t e s D

.

epar tm en t of

L abor,

C h il d r e n ’s B u r e a u ,
W ash in gton , M a rch 6 , 1 9 3 1 .

.

: There is transmitted herewith a report on Posture and Physical
Fitness, by Dr Armin Klein, director of the posture clinic of the
Massachusetts General Hospital, and Miss Leah C. Thomas, director
corrective gymnasium, Smith College. This is a report of a study
S ir

Chelsea Mas°f gr0UP trammg ^ Posture 111 an elementary school in
Acknowledgment is made to Dr. Frank E. Parlin, superintendent
of schools m Chelsea, for his cooperation during the study, and to
i^r. Kobert B Osgood, professor of orthopedic surgery, Harvard
Medical School, for generous assistance both in the survey and in
the preparation of the report.
Respectfully submitted.
Hon. W . N. D oak,

G race A bbott, C h ief.

Secretary o f Labor.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

<


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS
THE PROBLEM AND THE GROUP
A study of the posture of 1,708 elementary-school children in Chel­
sea, Mass., and the effect of group training upon the posture of the
individual children was carried out in 1923 and 1924. The study had
in the main two purposes: (1) To determine whether group instruc­
tion if carried out by the teachers and physical-education directors
in grade schools would result in improved posture for a majority of
children and whether it was possible to introduce such training into the
curriculum, and(2) to study the effect of posture training and improve­
ment in posture upon the nutritional condition, certain body measure­
ments, and general health as shown by absences from school due to
illness, and upon general morale as shown by improvement in scholar­
ship and deportment.
Poor body mechanics has been considered the cause of many ail­
ments. When no organic disturbances can be found to account for
the ailments complained of, medical men have often felt themselves
within the bounds of reason in attributing the symptoms to a func­
tional disturbance of the body mechanics. They were strengthened in
their belief also by the frequent cessation of symptoms which followed
the application of suitable orthopedic appliances or the correction of the
faulty posture by appropriate exercises.1
But all these reports were of the results attained by appliances and
instruction as remedial measures in cases where body mechanics had
been poor so long that compensation was insufficient to balance the
drain on the body reserve. The individuals treated usually complained
of dysmenorrhea, backache, cyclic vomiting, constipation, toxic arthri­
tis, or general debility without organic causes that could be found for
these conditions. It was therefore assumed that the associated
poor posture was the cause of the symptoms, and the relief obtained
by appropriate appliances or exercises was “ ergo propter hoc. ” The
effects of good body mechanics in all these cases were studied from
the point of view of remedial or palliative medicine. Though the
effects of correcting the poor posture in most cases were striking, no
figures were available to show whether or not maintenance of correct
body mechanics by any normal individual gave him any advantage
over his associates who were like him but who exhibited serious faults
of posture.
Fntz ?•>
D „ and Lloyd T. Brown, M. D.: The Use of Supports in Obscure Abdominal
Conditions (American Journal of Diseases of Children, vol. 21, No. 4 (April, 1921), pp. 347-356); and Talbot,
w if* - '•, and Lj9 yd T. Brown, M. D.: Bodily Mechanics; its relation to cyclic vomiting and other obscure
mtestmal conditions (American Journal of Diseases of Children, vol. 20, No. 3 (September, 1920), pp 168-187)


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

(

2

POSTURE AND PHYSICAL FITNESS

The results of college examinations and of the draft examinations
during the World War showed that about 80 per cent of the population
in early adult life used their bodies poorly. These people did not
necessarily show any signs of physical breakdown that could be attrib­
uted to poor posture. Their muscles and ligaments were still adequate
to support them in their poor posture without annoying symptoms.
The questions that arose therefore were whether the health of such
individuals would be improved if they were trained to maintain
better posture and whether their efficiency in their daily activities
would be increased.
.
.
To this end it was decided to note the effects of instruction in proper
body mechanics on grade-school children. Young children on the
whole are less likely than adults to have had poor posture long enough to
show any serious effects from it. They would therefore be the near­
est approach to the so-called normal in posture. Their bodies are
Umber, and they would therefore show the effects _of training more
quickly. They could be kept under control easily, since, if studied at
school, they would be under supervision for about five hours a day.
Also at school they would be amenable to instruction and readily
available in fairly large groups for study and periodic examination.
Again, in grade schools the effect of age and growth as factors could be
noted and studied. Finally, this seemed the simplest and easiest
method of obtaining a representative group of children for study.
The Williams School, a pubhc grade school in Chelsea, Mass., was
selected as the site for the experiment. The school had an attendance
of about 3,000 children. The district from which it draws its pupils
is largely Kussian Jewish.
The plan was to have the master of the school assign rooms from
each grade from the first to the ninth, inclusive, and to divide the
rooms into two groups, allotting similar numbers of rooms in each
grade for posture training and the regular gymnastics prescribed by
State regulation. The rooms were to be so selected that the number
of children in the grades of the group to receive posture training would
be approximately the same as the number in the corresponding grades
receiving only the regular gymnastics. It was further planned to take
measurements of the children in each group at regular intervals and
to keep records of their physical condition and school progress. The
group to receive the posture training was to show the results of this
type of physical education and the group to receive the regular
gymnastic exercises was to indicate the physical changes which would
have prevailed generally in the whole group had no posture training
been given. The difference in the changes observed in the two groups
would indicate the effects attributable to the special posture instruction and gxgpcisg»
This plan was carried out during the first year. The master of the
Williams School assigned 26 rooms, representing the school grades from
the first to the ninth, inclusive, and having about 1,000 children in
them. During the second year he assigned for further study 36 rooms,
there being 4 rooms in each grade from the first to the ninth, inclusive,
which represented in all 1,200 children. The rooms were divided as
agreed, one group receiving the special posture instruction and train­
ing and the other only the regular gymnastic exercises. Throughout


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

3

the report the group receiving the special training is referred to as the
posture group, and the group receiving only the regular gymnastics,
as the control group.
Arrangements were made to give each child a physical examination,
including body measurements (for items noted see schedule, Appendix,
p. 44) at the beginning and the end of the school year. He was also
photographed at those times according to Fradd’s method,2 and the
silhouettograph obtained was filed with his schedule. The child’s
height, standing and sitting, and his weight, all with shoes off and in
usual school apparel, were taken every month. His school attendance
or absence was noted for every quarter, and the absences were recorded
according to whether they were due to infectious diseases— colds, sore
throats, etc.— headaches, or other illnesses. Notation was also made
whether the child needed cathartics to relieve constipation and how
often in a quarter such cathartics were used. All medical attention
received outside of school was also recorded. The grade-room teacher
marked for each quarter the scholarship, deportment, and concentra­
tion in his work, of each child included in the study.
Though 2,200 children were studied thus, not all the schedules
could be used. For the purposes of the study only those schedules
could be included that showed a physical examination of the child at
the beginning and at the end of the school year. Almost one-fourth
of the schedules had to be discarded because they did not meet this
requirement. Some children died; some moved out of the school
district; some were moved out of the rooms in which they started at
the beginning of the year because of either promotions or demotions;
and finally, some were moved from their original rooms for adminis­
trative purposes. Some of the schedules were incomplete because of
the absence of the child from school when the examinations were made.
Practically no physical examinations were omitted because of
unwillingness of a child or of his parents to allow the examination or
any part of it. Some children happened to be in a “ control” room
during one year of the experiment and in a “ posture” room during the
other. If they were in the control class the first year and the posture
class the second, their schedules for both years were used; but if the
year of posture training came first, only that year’s schedule was in­
cluded in the tabulation. A few children were in the posture class and
a few in the control class both years of the study. Their schedules
for the first year were used with those of the children who were in­
cluded in the study group a single year. The schedules for the second
year have been subjected to Special analysis to show the effects of
longer training in posture and the postural tendencies of untrained
children over a period of two years.
The schedules of 1,708 children were sufficiently complete for inclu­
sion in the study. Of these 961 were in the trained, or posture, group
and 747 in the untrained, or control, group. (Table 1.) Seventy-six
children were in the posture group for two years, and 68 children were
in the control group for two years.
2 Fradd, Norman W.: A New Method of Recording Posture. Journal of Bone and Joint Surgery, vol. 5/
No. 4 (October, 1923), pp. 757, 758. See also Posture Exercises, by Armin Klein, M . D., and Leah C.
Thomas, p. 15 (U. S. Children’s Bureau Publication No. 165, Washington, 1926).

32292°—31------2


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

4

POSTURE AND PHYSICAL FITNESS
T a b l e 1.— N ativity of mother f o r children in the posture and control groups

Nativity of mother

Total........................... .......................
Total reported--------------------------------------

Control group

Posture group

Total

Per cent
Per cent
Per cent
Number distribu­ Number distribu­ Number distribu­
tion
tion
tion
747

1,708

961

1,670

961

100

709

100

99
5
93
64

100
6
89

4
3
11

706
39
631
473
42
32
22
62

100

White_________________ ___________
Native white------- ---------------------Foreign-born white— ....................
Russian-Jewish_____________
Other Jewish________________
Italian_____________________
Armenian___________ _______
Other foreign born-------------

1,661
89
1,526
1,089
149
69
47
172

99
5
91
65
9
4
3.
10

955
50
895
616
107
37
25
110

Nativity not reported.....................

46

3

10

1

36

Negro............ — --------- ------------------—
*J

9

1

6

1

3

yr .

h

6
5
3
9
5
0)

38

38
1

1 Less than 1 per cent.

The posture and control groups were similar in racial composition.
Both groups were composed predominantly of children of foreignbom mothers, and children of Russian and other Jewish maternity '
constituted 75 and 73 per cent, respectively. Children of Italian and
Armenian and other foreign-born mothers represented less than onefifth of each group, and children of native white mothers approximate­
ly one-twentieth of each. Since the two groups are similar in racial
composition, the racial traits and dietary customs would have had the
same influence in both posture and control groups and could have no
effect on the comparability of the figures.
There were 450 boys and 511 girls in the posture classes, and 388
boys and 359 girls in the control group. Thus, a sufficiently large
number of each sex were in the control and in the posture groups to
demonstrate the results of the experiment.
The youngest children were 5 years of age and the oldest 18, but the
largest proportion were between the ages of 9 and 15 years. (Table 2.)
This is true for both boys and girls and for both posture and control
groups. The comparatively small proportions in the younger age
periods are due to the method of room assignment, as the number of
rooms assigned in the lower grades was somewhat less than the number
assigned in the middle and upper grades. The small proportions in
the age periods over 15 years are due partly to the fact that many
intelligent children are in high school by the age of 15, and also to the
Massachusetts school-attendance laws which permit children of 16
years to leave school entirely for work and those of 14 to leave regular
school if they work part time and attend continuation school.
To sum u p: Two thousand two hundred children were observed,
and the records of 1,708 children were sufficiently complete for analy­
sis. Nine hundred and sixty-one were given instruction in proper
body mechanics and are spoken of in the report as the posture group.
The remainder (747) were not given such training but continued the


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

regular gymnastic exercises that they and the posture group had been
i°m^LPrevious
study. They served as a control with which
the changes of the posture group might be compared and are therefore
palled the control group. The two groups, except for the difference
in postural training, apparently are quite comparable because of the
similarity of distribution of the children within the groups according
to nationality, age, sex, and type of body build. The differences in
proportional relationships are so slight as to be statistically insignifi­
cant m their effect upon the results.
T able

2

-

-A g e at first examination of boys and girls in posture and control groups
Posture group
Boys

Age at first examina­
tion
Total

Control group
Girls

Num­
ber

Per
cent
distri­
bution

Num­
ber

449

100

504

Total.
Total reported..
5 years..
6 years..
7 years..
8 years. .
9 years..
10 years.
11 years.
12 years.
13 years.
14 years.
15 years.
16 years.
17 years.
18 years.

953

Total
Num­
ber

747

388

740

381

17
43
62
48
79
79

51
59
50
132
137

110

133
110
100
45
11
6

Per
cent
distri­
bution

Boys

110
85
93
70
41

0)

Girls

Per
cent
distri­
bution

Num­
ber

Per
cent
distri­
bution

359
100

100

23
25
'26
36
41
56
45
51
37
26
4
3

Age not reported.
1 Less than 1 per cent.

PROCEDURE OF STUDY OF EACH CHILD
All the children in both the control and the posture groups appeared
the examining room with their clothes lowered below their buttocks,
iiiach had his card (see Appendix, p. 44) on which were his name, address
nationality, sex, and age, the number of his schoolroom, and the date of
the examination. They were seen first by the orthopedic surgeon, who
graded them according to their appearance; i. e., on the basis of clinical estimation of their state of nutrition. The nutrition scale included
the following classes: A, children superior in health, vigorous looking
excellently nourished (amount of body fat), and of excellent color, with
well-developed muscles of good tone and firm skin and subcutaneous
tissue; -B, those that just fell short of the excellent (A); C, those who
were listless, whose muscles were poorly developed and lacked good
tone, and whose skin and subcutaneous tissue felt flabby; D, those
W mu °T^i marked malnutrition and definite need of care.
*- he children were also graded according to the manner in which
they stood before the examiner.
(See posture-standards charts,
pp. 6-11.)
f


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

6

POSTURE AND PHYSICAL FITNESS

Children were regarded as having A, or excellent, posture if the head
was balanced above the shoulders, the chest elevated and the breast
bone the part of the body farthest forward, the lower abdomen drawn in
and flat, and the back curves not exaggerated. In the lateral view

POSTURE STANDARDS
StocKy-Type Girls

Excellent Good

Poor

Bad

Children's Bureau, united states Department of Labor, Washington,D.C,I920.

the body parts would be so aligned that a perpendicular dropped
from the ear or just behind it would fall through the shoulder and
hip joints, and either through the ankle joints or just in front of them.
Children were classed as having B, or good, posture when the head


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

7

was held inclined only slightly forward and the chest slightly lowered,
when the lower abdomen was held in but not flat, so that, though per­
haps rounded, it did not protrude, and when the back curves were only
slightly exaggerated— enough, however, to show the early signs of a

POSTURE STANDARDS
StocKy-Type Boys

Children's Bureau, United States Department of Labor, Washington,0.0,1945.

hollow back. The posture was considered C, or poor, if the head was
distinctly forward, the chest flat, the abdomen relaxed so that it
was the part of the body farthest forward, and back curves distinctly
exaggerated. The D, or bad, posture grade was reserved for the child


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

8

POSTURE AND PHYSICAL FITNESS

whose head was dropped markedly forward and chest sunken and de­
pressed, whose abdomen was completely relaxed and protuberant, and
whose back curves were extremely exaggerated. #
The type of body build of the children was of interest because of its
relation to posture. Those called thin have a long, slender torso and

POSTURE STANDARDS
Th in -T yp e G irls

Excellent Good

A

Poor

Bad

C

D

Children's Bureau, united states Department of Labor, Washington, D.C,I9£0.

a long, thin neck. The extremities and their muscles are also long and
slender. They have the long, willowy, flexible bodies, and as they
stand poorly they sway backward from the lowest part of their spines
while the pelvis is tipped forward.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

9

POSTURE AND PHYSICAL FITNESS

Children classed as broad have a heavy broad-backed appearance
with large skeletons. The neck is short and chunky. The torso is
broad and relatively short. Flexibility is lacking in their sturdily built
spines. Their extremities are large and broad, their musculature
is heavy, and they themselves tend to be obese. Their poor posture

POSTURE STANDARDS
Th in -T yp e Boys

Excellent Good

a

b

Poor

C

Bad

D

Children's Bureau, United States Department of Labor, Washington, IXC,1926.

involves leaning backward from the middle of the back at the dorsolumbar junction.
All that did not fall readily into either of these groups were included
in the intermediate type. Their torso is intermediate in length and

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

10

POSTURE AND PHYSICAL FITNESS

breadth between the other two types. The normal rounded curves of
the spine, if they become exaggerated, appear mild and gradual.
The sharp curves of the thin type and the large fatty deposits of the
broad type are missing. The neck may be almost as long as that of the

POSTURE STANDARDS
Intermediate-Type G irls

Excellent Good

A

B

Poor

C

Bad

D

CtUldreifc Bureau, United states Department of Labor, WasKirxdton, 0.C.I926.

thin type; or it may be short, though hardly so thick and chunky as
in the broad type. When the children of intermediate-type body build
assume a relaxed attitude they bend backward not at the middle of the
back as do the broad, stocky ones, nor at the lowest part of the spines as
do the thin ones, but midway in the lower back or lumbar spin pi,


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

11

All the children were classified as to body type and nationality.
It was found that more of the children of Jewish mothers were of
the broad type than were the children of Italian or native white
mothers and the highest percentage of thin children was among the

STANDARDS
Interm ediate-Type Boys

Excellent

A

Children's Bureau, United states Department of Labor, Washington, D.C,I926.

children of native white mothers. (See Graph 1.) Apparently, if na­
tive whites were not of the intermediate type of body build, they were
more apt to be of the thin type; while Russian Jews, if they were not
of the intermediate type, were more apt to be of the broad type of
32292°— 31----- 3

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

12

POSTURE AND PHYSICAL FITNESS

physique. The pure thin type is seemingly most prevalent among the
offspring of native whites; the broad type is seen more among
the children of foreign-bom parents. Thus, since most of the children
studied were of Russian-Jewish, or at least foreign extraction, and since,
as was noted, all children not regarded as pure types were classified
as of the intermediate type, it is at once clear why more than 60 per
G r a p h l . —T y p e

o f b u il d o f

C h il d r e n o f n a t iv e W h it e
Bo r n M o t h e r s

and of

Fo r e i g n -

Per
cercfc

O ther
J e w is h
Th in

Intermediate C /L /Z

Italian

O ther
fo r e ig n

Broad

cent of the children studied were of the intermediate type, only 24 per
cent were broad, and 14 per cent were thin.3
The classification by type of body build showed that the children
of the various types were"similarly distributed in the posture and con8 It will be noted that these types conform to the anthropological types described by Osgood m 1921.
See Is There Any Evidence to Suggest That Poor Posture Bears Any Causal Relation to Poor Health
Children? by Robert B. Osgood, M. D. (Transactions of American Child Hygiene Associationat New Haven,
Conn , November 2-5, 1921, pp. 65-73, also Mother and Child, vol. 3, No. 1 (January, 1922), pp. 5-12).


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTTJKE AND PHYSICAL FITNESS

13

trol groups. (See Table 6.) The intermediate type predominated in both
groups, representing 59 per cent of the children who received posture
training and 64 per cent of the control children. Children of the
broad type constituted 27 per cent of the posture and 22 per cent of the
control group, and 14 per cent of the children in each group were
called thin.
After classifying the children into the thin, broad, or intermediate
type according to the characteristics of their body build, the ortho­
pedic surgeon noted on the cards any other orthopedic disabilities or
deformities.
Next, the surgeon noted the child’s type of breathing. If the ribs
were the site of most of the activity in respiration, the breathing was
recorded as costal; if the diaphragmatic excursion was most noticeable
in the upper abdomen the breathing was classified as upper abdominal;
and if the breathing action apparently was confined to the lower
abdomen it was so noted. Any combinations of these three types
were also set down on the cards.
Lastly, the orthopedic surgeon asked the child to “ draw in his
belly,” and observed which part of the child’s torso was most mobile
while he was trying to do so. Some children retracted the abdomen
directly. Others, apparently, found it easier to elevate the chest and
in this way drew in the abdomen indirectly. Still others combined
direct retraction of the abdominal muscles with indirect retraction by
means of elevation of the chest.
The child then passed along to a nurse, who took the height without
shoes, the weight while wearing ordinary school clothing, and measured
the circumference of the abdomen and also of the chest during inspira­
tion and expiration and between breaths. Another nurse measured
with calipers the depth of the chest during inspiration and expiration
and between breaths, the breadth of the chest between breaths, and
the depth of the abdomen at rest and when retracted. Still another
nurse took the vital-capacity readings on the spirometer into which the
child blew while sitting comfortably in a chair. The final readings by
another assistant were of the costal angle, formed by the lower ribs
at their junction with the breast bone or xyphoid cartilage, both
between breaths and during full inspiration. This was done with an
instrument made of two pieces of steel united at one end by a hinge
joint and opening sidewise on an arm on which degrees were marked.
About 30 children passing in single file by the orthopedic surgeon
and his four assistants could be examined within an hour.
After these observations were completed, the child was photographed
by the method advocated by Norman Fradd,4 being told merely to
stand in front of the camera for his photograph. During the entire
examination and at subsequent examinations the child was not told
how he should stand. Stencil numbers corresponding to the children’s
examination-card numbers were fixed on the screen during the photog­
raphy so as to identify the pictures. A male assistant for the boys
and a female assistant for the girls did the photographing, while a
second assistant kept the children in single file passing regularly to a
position in front of the camera. In this way it was possible after a
4 Fradd, Norman W.: A New Method of Recording Posture. Journal of Bone and Joint Surgery, vol. 5,
No. 4 (October, 1923), pp. 757-758.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

14

POSTURE AND PHYSICAL FITNESS

very little experience to photograph between 50 and 60 children in an
hour.
These photographs were later developed and graded according to
the type of body mechanics manifested. They were then attached to
the examination cards after first having been shown to the children.
To each child in the posture group, as he was shown his own photo­
graph, were demonstrated the errors in his body mechanics and the
methods by which he could correct them, as he was urged to do.
Every month thereafter the children’s weight, and sitting and stand­
ing height were taken. The same assistants took these readings
throughout the year. The other readings and observations described
were likewise always taken by the same assistants throughout all
examinations both at the beginning and at the end of the school terms.
At the end of every quarter of the school term the grade teacher
noted on his card the number of sessions each child was absent from
school for colds, sore throats, headaches, or other personal illnesses.
She also noted his scholarship, his deportment, and the degree of
concentration in his work. She graded each child in these last char­
acteristics according to the scale of A, B, C, and D.
After the child was examined by the orthopedic surgeon and his
corps of assistants, he was ready, if he was in the posture group, for
his posture training. The children in the control group, of course,
were allowed to continue with the usual school work without posture
training.
All instruction was guided by the orthopedic surgeon and his first
assistant. The latter was the supervisor in active charge of the posture
instruction to the children. She was a physical instructor with much
experience in posture work. She first taught the grade teachers the
fundamentals of good posture, so that they knew how to use their own
bodies correctly and to teach these fundamentals* to others. She
herself started the children in their training by giving each child his
first lessons in the fundamentals of good posture. She then visited
each posture room once a week to conduct each class herself and to note
any occasion for stressing certain aspects of the instruction with the
teachers or with the children. She also met the assistant supervisors
and the orthopedic surgeon periodically for conference on the problems
that arose in regard to the routine of instruction.
The assistant supervisors were girls from the graduating class of a
neighboring physical-education school, who had had their academic in­
struction in body mechanics for two years while at school. They came
once a week for a morning’s work with the children. They were observed,
while instructing the children, by a supervisor from their own physicaleducation school. Each girl had the children in about six posture
rooms assigned to her for intensive instruction in body mechanics.
She spent about 20 minutes in each room trying to supplement the
posture instruction given daily by the grade teachers. During this
time she conducted the classes assigned to her through the prescribed
exercises, and especially assisted the grade teacher in starting the
children on any new exercises to which they might have advanced.
She reported to the supervisor and the orthopedic surgeon in charge all
children that needed special attention and the details of these require­
ments, and also reported the grade teachers under her assignment who
needed special support in imparting good posture to the children.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

15

POSTURE AND PHYSICAL FITNESS

The grade teachers in the posture rooms, as has been said, were first
taught the fundamentals of good posture and methods of teaching them.
They also observed the methods used by the supervisor and the assist­
ant supervisors on their visits to the classroom. They attended a
course of lectures ]by eminent orthopedic surgeons and in this way
were continually stimulated in their instruction of good body mechan­
ics. They taught the children the exercises formally for 10 minutes
each day, but as they had their pupils under constant supervision for
the whole school day, they were able to watch the children’s posture
for about 5 hours. Thus they had the best opportunity to correct the
child who had faulty habits of body carriage and to stimulate him
to form better habits of posture while exercising formally and while
doing the rest of the school-day’s work.
The exercises taught by the entire corps may be found in Posture
Exercises, a handbook for schools and for teachers of physical educa­
tion, United States Children’s Bureau Publication No. 165.
THE POSTURE OF THE SELECTED GROUP BEFORE
TRAINING
The first examination of the 1,708 children considered in this analy­
sis disclosed that only 1 per cent had A posture, less than 10 per cent
had B posture, 61 per cent ranked C, and 31 per cent ranked D .
(Table 3.) Thus at the beginning of the survey 92 per cent had poor
posture.
Table 3.—

Posture grade at first examination and type o f build o f all children in­
cluded in the study
Total children

Posture grade at first
examination

Type of build

Thin
Intermediate
Broad
Per cent
Number distribu­
Per cent
Per cent
Per cent
tion
Number distribu­ Number distribu­ Number distribu­
tion
tion
tion

Total_________

1,708

100

246

100

1,044

A _________________
B _______
_______
C __________________
D _______________

9
124
1,039
536

1
7
61
31

2
14
122
108

1
6
50
44

5
72
629
338

0

100

418

7
60
32

2
38
288
90

100
(!)

9
69
22

1 Less than 1 per cent.

. _As the group studied was selected at random in a public school, this
is probably what might be expected for any group of children, though
the figures might vary somewhat, depending on whether the group
was predominantly boys or girls. Boys apparently use their bodies
mechanically better than girls. (See Graph 2.) Although there was
little difference in the proportion of boys and girls having good
posture (9 and 7 per cent, respectively), a much larger proportion of
the boys (65 per cent) than of the girls (56 per cent) had poor posture
(grade C), and a smaller percentage of the boys (26 per cent) than of
the girls (37 per cent) had bad posture (grade D ).


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

16

POSTURE AND PHYSICAL FITNESS

Body mechanics of the children studied showed a definite though
slight relationship to age. (See Graph 3.) The youngest children
(those under 7 years of age) had better posture than those in the im­
mediately succeeding ages. But at the age of 7 and less than 9 years,
the percentage who had good posture (i. e., those who ranked either A or
B) dropped from 5 to less than 1. In other words, the child when he
enters school has a better posture apparently than he has after he has
been in school for a while. In his so-called preschool age, he is as a
rule out of doors for a large part of the day and leads an active life.
He then abruptly changes from a method of living conducive to robust,
vigorous health, with presumably good muscle control to a less active,
more sedentary occupation— going to school. This with the unac­
customed confinement, especially in seats and at desks (rarely properly
adjusted), together with the strain of the usually sudden transition
G r a p h 2.—P o s t u r e G r a d e

0

10

£0

30

o f b o y s and g ir l s a t

40

P e r cervt
50

Go

F i r s t Ex a m i n a t i o n

TO

6Q

9.0

100

6oya

Gir!.s

WMmm,
Po-st; ure «Srade»
A and B

cY Z Z A

from play to work, undoubtedly contributes to weakened muscular con­
trol and therefore to poor posture. Apparently the effort on the part
of the child to accommodate himself to his new mode of existence
tires him, and is evidenced in the posture of fatigue— the C and D
postures. As the child accustoms himself to his environment the
strain gradually slackens. The posture of fatigue is less evident, for
after the initial drop in good posture at 7 to 9 years of age there is a
slight but steady increase in the percentage with good posture (A and
B) in each succeeding year of age.
Practically all (99 per cent) of the children had poor posture in the
age period 7 and under 9 years, but from this age onward the preva­
lence of poor posture gradually decreased until in the age group 14
years and over, 88 per cent of the children were found to have poor
posture. When this figure is compared with the results of Lee and


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

17

B row n5 in their examination of Harvard freshmen in 1916 and 1919, a
definite correspondence is evident. Their subjects were about 18 or 19
years of age, and about 80 per cent had poor posture. Though good
posture is somewhat more prevalent as children grow older, as is shown
by the increase in the percentage of children having good posture in
the higher age periods, poor posture predominates markedly. Poor
body mechanics, although most common among young children, is
not outgrown to any marked degree.
Body mechanics also showed a definite relationship to type of body
build. The greatest percentage of good posture (A and B) was
found among the broad-type children, the next largest percentage
was found among children of intermediate build, and the smallest
G r a p h 3.—P o s t u r e G r a d e a t F i r s t e x a m i n a t i o n
S p e c if ie d a g e p e r i o d s

o f b o y s a n d g ir u s of

Per
BoyvS
cent
100.---- --- ---- --- ---

G irls

Per­
cent

_ __ __ __ __ ,J00
-90

90 -

.80

«T2 3IT
§'b
Sii lb
t- 3 <r\3 i f
II
Posture ¿ra.de.

AamJBHH

CX / / X

0I__ I

among thin children. This is about what one would expect, for the
anatomical construction of the bodies of broad children precludes, as
a rule, the assumption of the exaggerated, almost grotesque, attitudes
frequently found among thinner children. The latter showed the larg­
est proportion (93 per cent) of poor posture (C and D ). As further
evidence that the intermediate type is a truly compromise type it
showed almost as large a percentage of individuals having poor pos­
ture (93 per cent) as the thin type but did not have so large a proportion
in the E) grade (32 per cent) as did the thin type (44 per cent). Most
of the intermediate and broad children with poor body mechanics
were in the C group (60 and 69 per cent, respectively).
5 Brown, Lloyd T., M. D., F. A. C. S.: A Combined Medical and Postural Examination of 746 Young
Adults (American Journal of Orthopedic Surgery, vol. 15, No. 11 (November, 1917), pp. 774-787); and Lee,
Roger I „ William H. Geer, and Lloyd T. Brown: Bodily Mechanics in Harvard Freshmen (American
Physical Education Review, vol. 25, No. 8 (November, 1920), pp. 337-342).


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

18

POSTURE AND PHYSICAL FITNESS

THE IMPROVEMENT SHOWN IN POSTURE AFTER TRAINING
The incidence of excellent, good, poor, and bad posture in the pos­
ture and control classes was practically identical at the beginning of
the school year when the children were first examined, and had it not
been for the posture training it is assumed that the postural habits of
the children in the different classes would have been correspondingly
similar at the end of the year. Instead of this similarity at the end of
the year, however, it was found that the distribution of posture grades
among the trained children was significantly different from that among
the control children. (See Graph 4.)
Good posture was found more frequently among the children in the
posture classes than among those in the control classes, which had
G r a p h 4.—P o s t u r e G r a d e
d r e n in t h e

a t Fir s t
Po s t u r e

a n d S e c o n d e x a m in a t io n s o f
and c o n tr o l G roups

C h il ­

P er cent;
0

10

2,0

30

40

50

60

TO

80

9.0

100

Posture ¿rad e at fi ret examination

Posture ¿rade at second examination

Posture ¿roup

HB9HH
AandB Ü

P o s t u r e ocSrado

only the calisthenic exercises usually given to the school children. In
the control class at the end of the school year 10 per cent had improved
their posture, 22 per cent had worse posture than at the beginning of
the year, and 67 per cent received the same grade that they had for­
merly. (Table 4.) In the posture class, on the other hand, 62 per
cent of the children had improved in posture by the end of the year,
1 per cent had regressed, and 37 per cent had not changed.
At the end of the school year none of the 47 children originally
graded B in the control class had progressed to A grade; 23 received the
same grade at the end as at the beginning, and 24 received a lower
grade, either C o r D . Of those who ranked C originally, only 4 per
cent progressed to a B posture. The majority, about two-thirds, did

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

19

POSTURE AND PHYSICAL FITNESS

not change at all, and one-third regressed. Of those who ranked D
originally, about one-quarter improved, but most of them progressed
only one grade to C; only 4 per cent improved to B posture, and
none to A.
Table 4.—

Posture grade at first examination and change in 'posture fo r children in
the posture and control groups

Change in posture
Improvement
Posture grade at
first examination

I Total
Posture group. 9S1

Control group. 747
A
B

c

D ________________

Grade at
second
examination

Total

6
A
77
B
_________
591
C
D ............... .............. 287

3
47
448
249

Num­ Per A
ber cent
598

No change

B

C

Grade at
second
examination

Total

351

39
318
241

51
54
84

39
89 229
22 102 117

4
35
266
46

45
45
16

78

10

26

504

67

52 __

37

17
9

52

£92
138

4 35 266 46
4

1
4
24

Grade at
second
examination

Total

Per
Num­ Per
D Num­
ber cent A B C D ber cent A B C D

62 150 331 117

17
tl

Regression

65
76

35

12
2
3

266

1 ___

2

3

7

2
4
1

3

7

46
1 23 292 188

165

1

2
24
139

23

292

188

22 ___

1 19 145
1

31

1
18

6
139

After one year’s training a definite improvement was evident in the
posture class. One-half of those who had B posture (51 per cent) im­
proved, obviously to A ; 54 per cent of those who started with C improved,
as did 84 per cent of those with D ; about 45 per cent of the original B
and C posture children did not change their grades, and about 4 per cent
regressed. The percentage of regression was greater in the B group,
but none of these children fell below C grade. Of those who improved,
72 per cent who were originally rated C progressed to B, and 28 per
cent progressed to A. Of the original D grade that improved, 9 per
cent progressed three grades to an A rating; nearly one-half of the
remaining D children who improved progressed to B, and the others
got C.
Thus the effect of posture training is shown by the much greater
frequency of improvement in posture by the end of the school year
in the trained class than in the control class. More than six-tenths
of the trained children and only one-tenth of the untrained children
improved their posture. Even when there was no improvement, the
posture of almost all the trained group remained the same, while that
of many in the untrained group grew worse.
Not only did more of the children trained in posture improve, but
their degree of improvement was greater than that of the untrained
children. Sixty-three per cent of the trained children who could
improve (that is, children receiving B, C, or D grade at the first
examination) had progressed at least one grade, whereas the corre­
sponding percentage for the control children was only 10. When
the possible improvement was two grades, 24 per cent of the trained
32292°—31---- -4

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

20

POSTURE AND PHYSICAL FITNESS

children and only 1 per cent of the untrained children improved to
that extent. Among those who couid have improved three grades,
8 per cent of the posture group but none of the control group did so.
In the control group it was chiefly the children who had D posture at
the first examination who improved (24 per cent). Only a few of
those who had C posture (4 per cent) and none who had B posture
improved during the school year. In the posture class half the children
who received grade B and half the children who received grade C
improved, as well as 84 per cent of those whose original posture grade
was D.
. . .
The results of the posture training did not vary greatly with age but
were significantly different among boys and girls. (See Graph 5.)
G r a p h 5 —c h a n g e

in

P o s t u r e o f Bo y s a n d
Co n t r o l G r o u ps

g i r l s in t h e p o s t u r e a n d

Per cen*t
0

10

20

30

40

50

60

70

80

90

»00

Boy'cS
Posture
group
Control
group

G ir liS
Posture
group
Control
group
gnm aH

Improvement

HSBHB

No improvement 1

1

Under training, 55 per cent of the boys improved their posture as
compared with 68 per cent of the girls. (Table 5.) This difference
is noticeable among the untrained children also, for 6 per cent of the
boys and 15 per cent of the girls in the control group improved m
posture during the year they were under observation.
. .
Among the boys under 8 years of age who had posture training
improvement took place less frequently than among the older boys,
for only 41 per cent of these young boys improved under training as
compared with 63 per cent in the age period between 10 and 12. The
apparent failure of young boys to improve under traimng suggested
by these figures may be due to the smallness of the numbers m the
lower age group. On the other hand, it may be associated with lack
of coordination and cooperation and the other physical factors °

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

21

POSTURE AND PHYSICAL FITNESS

maladjustment operating in the early years of school life. Among
girls the percentage showing improvement was practically the same
(slightly more than two-thirds) in each group.
T able 5.—

Change in posture among boys and girls of specified age periods in the
posture and control groups
Chango in posture
Girls

Boys
Group and age period

improve­
improve­
Improvement No ment
Improvement No ment
Total
Total
(num­
(num­
ber) Num­ Per Num­ Per
ber) Num­ Per Num­ Per
cent
cent
ber
cent
ber
ber
cent
ber

Posture group--------------

450

249

55

201

45

511

349

68

162

32

Under 8 years----------------------8 years, under 10---------- _ . . .
10 years, under 12___________
12 years, under 14____
____
14 years and over-----------------

59
83
125
122
60

24
45
79
65
36

41
54
63
53
60

35
38
46
57
24
1

59
46
37
47
40

60
99
122
121
102
7

41
67
82
82
71
6

68
68
67
68
70

19
32
40
39
31
1

32
32
33
32
30

Control group_________

388

25

6

363

94

359

53

15

306

85

Under 8 years_______________
8 years, under 10______ _____
10 years, under 12___________
12 years, under 14.. ---------- .
14 years and over____ _ -----

56
62
97
96
70
7

1
8
5
10
1

2
13
5
10
1

55
54
92
86
69
7

98
87
95
90
99

66
65
92
82
54

6
7
10
14
16

9
11
11
17
30

60
58
82
68
38

91
89
89
83
70

1

Type of build apparently bears no well-marked relationship to
change in posture in either the control or the posture group. Under
training, 61 per cent of the thin children of the posture group improved
in posture as compared with 60 per cent of the children of intermediate
build and 67 per cent of the children of the broad type.^ (Table 6.)
In the control group 9 per cent of the thin children improved as
compared with 10 per cent of the intermediate and 12 per cent of the
broad type. These percentages at first seem to indicate that children
of the broad type more frequently improve in posture than children
of either the thin or the intermediate type. Careful analysis, however,
shows that the differences are too slight to be significant in view of the
small number of children of each type of body build.
T able 6.—

T yp e o f build and change in posture fo r children in the posture and
control groups
Change in posture

Type of build

Total
•children

Regression

No change

Improvement

Number Per cent Number

Per cent Numbor

Per cent

Posture group..................

961

598

62

351

37

12

1

Thin_____________ _____ _____
Intermediate-------- --------------- .
Broad......... - ------- -------------

138
567
256

84
343
171

61
60
67

53
216
82

38
38
32

1
8
3

1
1
1

Control group.... ..............

747

78

10

504

67

165

22

T h in ..’__ ____________ _____ _
Intermediate_________________
Broad____ ___________________

108
477
162

10
48
20

9
10
12

73
322
109

68
68
67

25
107
33

23
22
20


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

22

POSTURE AND PHYSICAL FITNESS

. There were 76 children who had two years* training and 68 who were
in control classes for two years. Although the number of children in
each group was comparatively small, the distribution of posture grades
for the small groups at the beginning of the year was similar to that of
the whole group of 1,708 children, and the findings in the posture and
control groups at the end of the first year were approximately the same
as those among the total posture and total control groups at that time.
These small groups of children are probably fairly typical of all children
included in the study. The results are suggestive of those which
would be obtained under training and of the postural change which
would be found without training among school children during an
interval of two years. The percentages throughout correspond so
closely that it is safe to assume that the experience of the children
for whom 2-year records were available affords a fair indication of
what might be expected in any average group of children during a
2-year period.
In the group of 76 children to whom two yeafs* posture training
was given, 73 improved in posture at some time during the period
and 67 maintained their improvement so that their posture was
better at the end of the two years* training than at the beginning.
Of the 3 who failed to show improvement at any time during the
two years, only 1 had worse posture than at first; 2 had no change
m posture grade. The 6 other children improved during the period
but their better posture did not become habitual, and the final
grade was the same as that received before training. These figures
indicate that there are few children whose posture can not be im­
proved under proper training. In contrast with this, of the 68
children in the control group for whom there were records over a
2-year period, only 7 had a better grade at the end of the period
than at the beginning; 36 had the same grade; and 23 had poorer
posture (last posture grade was not reported for 2 children). The
percentage of improvement in the second year was about one-half
^ Was *n
y ear (8 and 13 per cent, respectively),
and the regression was one-half greater, On the other hand, among
the trained children improvement was nearly as great in the second
year as in the first, with no increase in the regression, and most
striking of all was the fact that more than one-half of those who im­
proved during the first year improved also during the second. Again,
those of this group who had good posture (A or B) at the begin­
ning of the second year maintained it and two-thirds of the others
improved.
Regression to a poorer posture during the summer vacation when
posture training ceased was twice as great among those who had
improved as among those whose posture did not change in the first
year. All but 4, however, of the 25 whose posture grew worse
during this vacation, improved during the second school year. The
summer vacation with its cessation of posture training was the
occasion for the child to forget to a certain degree what he had
learned about good body mechanics. This is undoubtedly what
happens with any subject taught during the school year. The
habits of good posture evidently were not definitely fixed in a single
year.
This regression was not so evident in the control group. Here
only 19 per cent had poorer posture in contrast to the_33 per cent

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

23

of the posture group who were worse after a summer’s vacation.
The control group had no training in posture to forget. In fact,
if school life is one cause of poor posture, as earlier tables would
seem to show, then the removal of this cause during the vacation
period for a group unaffected by other factors such as posture train-,
ing, should result in improved posture at the end of the vacation.
About one-fourth of the untrained children did show this im­
provement. Indeed, owing to the active outdoor healthful life of
the vacation period, more improved at this time than during the
school terms. The posture of only about one-fifth of the children
in the posture group, on the other hand, with the harmful effects
of school life neutralized as it were by posture training, was im­
proved through the helpful effects of vacation*. More forgot what
they had learned about posture and proved thereby that children
will show a reversion to poorer posture with a cessation of training
unless the training is continued long enough for the maintenance
of good posture to become a fixed habit.
The experience of the children for whom 2-year records are avail­
able suggests that the proportion of children free from structural
defects whose posture can not be improved is less than 5 per cent,
and that some children require longer training than others. About
nine times as many children improved in posture with training as
improved without training. Since good ‘ posture once acquired
(vacation periods excepted) was maintained, on the whole, over
the 2-year period of observation, it seems reasonable to expect that
with posture instruction continuous throughout grade school, the
habits of good body mechanics will become fixed and lasting.
POSTURE AND NUTRITIONAL CONDITION
Between posture and the child’s nutritional condition there is
undoubtedly a relationship, but it is difficult to evaluate since it
is probable that improvement in either may lead to improvement
in the other. The clinical *estimate of the nutritional condition
used in this study covered a number of factors such as general con­
dition of health, amount of body fat, the texture of skin and sub­
cutaneous tissues, color, and muscular development. It is ob­
viously a clinical estimate of the child’s general condition and
should be thought of as such in the following discussion.
An estimate of the nutritional condition of all the children in the
study was made at the beginning of the school year and again at
the end of the school year. Not only, therefore, could the relation
of the child’s nutritional condition to his posture be made before
posture training, but also after training; that is, the results of train­
ing may be shown by improvement in posture or nutritional con­
dition or both, no change in either, or actual regression in either.
The following data will show that though there is apparently a
slight preponderance of improvement in nutritional condition with
improvement in posture, there is also an improvement in posture
with improvement in nutritional condition. It would seem im­
possible to demonstrate which is the causal factor, but it will be
obvious that there is a relationship between the two.
The relation of nutritional condition to posture in the total group
(both posture and control groups) at the beginning of the study

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

24

POSTURE AND PHYSICAL FITNESS

is shown in Graph 6. More than three-fourths of the children who
had good posture (A and B at the first examination) also were in
clinically good nutritional condition.
(For scale of the clinical
estimate of the nutritional condition, see p. 23.) Less than one-fourth
with good posture had a C grade of nutritional condition, and none
had bad (D) nutritional condition. With poorer posture the per­
centage of good nutritional condition was lower and that of poor
and bad nutritional condition correspondingly higher. Nutritional
condition of grade D was present among children receiving C and D
posture grades. Graph 7 shows the proportion of A and B, C, and
D posture in the children having A and B, C, or D nutritional con­
dition at the first examination. These two graphs would indicate
that the children with good posture were generally in better nuG r a p h 6 .— N u t r i t i o n a l . C o n d i t i o n a t F i r s t e x a m i n a t i o n o f C h i l d r e n
R E C E I V I N G S P E C IF IE D P O S T U R E G R A D E S

Per cent

A —
B

K Z 2

c PZ 7 3
O

□

tritional condition than children whose body mechanics were of
mediocre character, and that children with more satisfactory nu­
tritional condition tended to have better posture.
Before discussing the nutritional condition of the children in the
posture and control groups separately, it should be brought out
that there are certain factors other than posture which are also
associated with the nutritional condition. Fewer boys than girls
(53 per cent as compared with 68 per cent) were in good (A and
B) nutritional condition at first examination. In this connection it
will be recalled that good posture was more prevalent among boys
than girls at that time. The variation of nutritional condition
with age was also quite marked. A much smaller proportion of
both boys and girls of the lower ages than of the upper ages had
good nutrition. (See Graph 8.) Nationality of mother also should

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

25

POSTURE AND PHYSICAL FITNESS

probably be taken into consideration, since a larger proportion of the
children of both Russian-Jewish and other Jewish mothers were
better nourished than those who were of native white or of Italian
mothers. The percentages of children with good nutritional condition
in these groups were 63, 61, 54, and 54, respectively. Type of build
and nutrition were also closely related, the broad type having as
a rule good nutrition (95 per cent), and the thin type poor nutrition
(only 29 per cent having good nutrition). It should be remembered
in this connection that both nutritional condition and body type
are graded by clinical estimate and that thinness and obesity are
factors entering into both estimates. (See p. 8 for description of
of estimate of body type.)
The part which diet and other health habits have played in bringing
about the nutritional condition has not been considered in this study.
G r a p h 7.—P o s t u r e G r a d e a t F i r s t Ex a m i n a t i o n o f C h il d r e n W ith
S p e c if ie d n u t r i t i o n a l C o n d it io n

0

>0

20

30

S iS '

40

P er cen."t
50
60

•
70

80

90

>00

.«■-»

Posture <£ra.de>

AandB I H H

C XZZA

d C=Z3

It is not possible to show from the data available how much the above
factors are influencing the relationship of posture and nutritional
condition.
Comparison of the nutritional condition at first examination of the
children in the posture and control groups shows that the posture
group, though selected at random, contained a larger proportion of
children having A and B nutritional condition (63 per cent) than did
the control group (57 per cent) which was similarly selected. This
difference, though small, is significant. On this account it has been
necessary to study the change among selected children rather than
compare the entire posture and control groups.
The effect of posture training on nutritional condition and the
effect of nutritional condition on improvement in posture can best be
shown by studying those children for whom there was a possibility
of improvement in either posture or nutritional condition; that is,

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

26

POSTURE AND PHYSICAL FITNESS

those who were graded B, C, or D at first examination. During the
training period it would be possible for children in this group to im­
prove one to three grades in either posture or nutritional condition,
to show no change in grade, or to regress to a lower grade with the
exception of those having D, who were already lowest. Those children
who were given A in posture or nutritional condition at the first
examination had no opportunity for improvement but did have oppor­
tunity for regression. Those children who had A at both first and last
examinations had no opportunity to improve and did not regress.
These last are therefore kept as a separate group and are not
included when improvement is being studied.
Table 7 shows the relation of change in posture to change in nutri­
tional condition. Improvement in nutritional condition during the
school year was not striking in either the posture or the control
G r a p h 8 .— N u t r i t i o n G r a d e a t f i r s t E x a m i n a t i o n o f B o y s a n d g i r l s
o f S p e c if ie d a g e p e r io d s
Per»
ce>vt

Boyns

G irl«

i

Per
cent

Nutritional condition.
A and

group. Of those having the opportunity to improve in nutritional
condition, 20 per cent did improve in the posture group, whereas
only 15 per cent improved in the control group. This difference is
small, but it is statistically significant. Improvement in condition
was found more frequently among the children who received posture
training than among the control group which had regulation gymna­
sium work. If improvement in nutritional condition is studied in the
group of posture-trained children only, comparing those who showed
improvement in posture under training and those who showed no
change in posture, it will be seen that there was a slightly larger
proportion of improvement in nutritional condition in those who actu­
ally improved in posture with training (24 per cent) than in those who
showed no change in posture (15 per cent). This difference, though not
large, is likewise significant. These figures show that posture train
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

27

POSTURE AND PHYSICAL FITNESS

ing, particularly when the children cooperate sufficiently to improve
their posture, is associated with improvement in nutrition.
T able 7.—

Change in nutritional condition and change in 'posture fo r children in the
posture and control groups

Change in nutritional condition

Change in posture

Total chil­
dren

Improve­ No change Regression No change
ment (re­
(received
(received
(received
ceived B, B> C, or D A, B, or C A at both
C, or D at
at first
first and
at first
first exami­ examina­
examina­ second ex­
nation)
tion)
tion)
amination)

Not re­
ported

Posture group___________

961

132

499

20

310

Improvement__ ______________
No change . . . _______ _______
Regression..____________ _____

608
351
12

94
38

290
201
8

5
14
1

209
98
3

Control group___________

747

83

412

45

206

1

78
504
165

9
60
14

32
283
97

2
30
13

35
130
41

1

Improvement_________________
Nochange........................ .........
Regression........... ............ ........... •

The effect of nutritional condition on the* results of posture training
may be shown by comparing the frequency of improvement in posture
under training among children receiving the specified nutrition grades.
Of those children in the posture group who were given A in nutritional
condition at the first examination, 66 per cent improved in posture
under training, as compared with 61 per cent of those with grade B
nutrition, and 60 per cent of those with grades C and D nutrition at
first examination. These successive differences are not significant,
but the trend suggests that had larger numbers of children been in­
cluded in the experiment statistically significant results might have
been obtained.
If, however, improvement in nutritional condition is considered in
relation to improvement in posture among children in the posture
group, it is found that 71 per cent of those who improved in nutritional
condition improved also in posture, whereas only 58 per cent of those
who showed no change in nutritional condition improved in posture,
a difference of 13 per cent. Of those children who were A in nutritional
condition at first examination and at last examination, 67 per cent
showed an improvement in posture. Improvement in posture was
found, therefore, to be associated with improvement in nutritional con­
dition, or ¡¡with an A grade of nutritional condition which was main­
tained through the training period.
If the relation of improvement in posture during the year to nutri­
tional condition at first examination is considered in the control group
of children who had no posture training, it is found that 16 per cent
of those with nutritional condition A, 10 per cent of those with B, and
7 per cent of those with C or D showed improvement in posture. The
difference between the percentages for the best and poorest groups
is small but significant. Even without postural training, posture
improves more frequently among those who have the best nutri­
tional condition.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

28

POSTURE AND PHYSICAL FITNESS

THE RELATION OF POSTURE TO SCHOOL WORK
Do children trained to acquire improved body mechanics show
any evidence of improved efficiency in their daily activity— their
school work?
To investigate this problem, a record was kept for each pupil of his
absences due to his personal illness for each quarter of the school year.
The first quarter ran from the opening of school to November 20, the
second from November 21 to January 20, the third from January 21 to
April 20, and the last quarter ran from April 21 to the end of the school
year. The teachers also graded each child in scholarship and deport­
ment for each quarter. N o child knew that any such records were
being kept for the survey. He could, therefore, in no way consciously
affect the records. The teachers themselves did not know why these
records were kept.
Variation in the frequency of absence due to illness for school chil­
dren is generally shown by morbidity or absence rates per 1,000 chil­
dren, which are reduced to the basis of a school year of 180 days, the
rate for any period such as a quarter representing the rate that would
have resulted if absence had continued throughout the year at the
rate which occurred during the quarter. By this method the rates for
the different quarters, which vary in length, are reduced to a com­
mon basis and made comparable. The fact that part of the absences
occurred in 1923-24 and part in 1924-25 has been taken into account
in the calculations.
In the fall quarter the rate for absence due to illness for the chil­
dren in the posture group was 3,418 per 1,000 children per school year
of 180 days, as compared with 2,660 in the control class, or 28 per cent
higher than that of the control. In the spring quarter the rate for the
posture group was 2,104 as compared with 2,702 in the control, or 22
per cent lower than that of the control. The rate of absence due to
sickness in the posture class was thus 1,314 points, or 38 per cent,
lower in the spring quarter than it had been in the fall, whereas in the
control class the rate for the spring quarter showed an increase of 42
points, or 2 per cent, over the rate of the fall.
The experience in the control class shows the same general tenden­
cies as other studies of morbidity and absence from school. A rate
for the 3-month period, September to November, 1922, in Hagerstown,
Md., is 3,950 per 1,000 children per school year of 180 days as com­
pared with 7,238 and 4,723 for the spring periods, April and M ay of 1922
and 1923, respectively. The study of sickness among school children
in 13 localities of Missouri in the school year 1919-20 gives rates of
4,893 for September, October, and November combined, as compared
with 8,734 for the months April and May.6
In the first quarter of the school year the rate of absence from
school on account of illness of the posture-trained children was
higher than that of the children in the control group. B y spring,
however, the rate for the posture group had decreased so that it
was considerably below what it had been in the fall and also much
below that of the control group. In the control group, in contrast
6 Morbidity among School Children in Hagerstown, Md., by Selwyn D. Collins, pp. 2391 2423 (Public
Health Reports, vol. 39, No. 38); Sickness among School Children, by Selwyn D. Collins, pp. 1549-1559
(U. S. Public Health Reports, vol. 36, No. 27). The rates shown in these reports are for school days ol
calendar months. These rates have been combined on a general quarterly basis per 1,000 children per
school year of 180 days.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

29

with the posture, the rate was a few points higher than it had been
in the fall. Although the increase was insufficient to be statisti­
cally significant, it is of interest in that the direction was in accord
with the findings of other studies. The tendency of the rate in
the spring quarter for the children who received posture training is
directly opposite to that shown by other studies of absence from
school due to illness in that the spring rate for the posture group is
lower than that of the fall. Both the Hagerstown and the Missouri
study showed considerably higher rates for absence due to sickness in
the spring than in the fall. There seems to be no question that the
posture training was associated with the low morbidity rates of the
spring quarter among children who had been trained during the year.
The rates of the control group and those of the Hagerstown and .
Missouri studies would seem to bear out the theory that children
are in better health in the fall following the summer vacation and
the long play periods out of doors. During the school year, however,
the children are kept indoors concentrating on their studies and
sitting in poor positions. The natural result is increase in absence
due to illness. That posture training and improvement in body
mechanics are beneficial and improve the health of the child seems
to be demonstrated by these figures.
There were also the following indications of the relationship be­
tween posture and scholarship among children for whom scholar­
ship was reported during the first and last quarters: 28 per pent of
the children trained in posture improved in scholarship during the
school year as compared with 20 per cent of the control children.
In the posture group comparison shows that there was no signifi­
cant difference in the proportion of children who improved in scholar­
ship between the group that improved in posture (29 per cent) and
the group that showed no change (27 per cent); but in the control
group 24 per cent of the children who improved in posture also im­
proved in scholarship, as compared with 18 per cent of the children
whose posture did not change.
Improved deportment also seemed to be associated with posture
training. Among children not receiving A in deportment during
both first and last quarters the percentage showing improved deport­
ment was higher among the children trained in posture (40 per cent)
than among the control children (20 per cent). Also regression in
deportment was less frequent among the posture-trained children
(6 per cent) than among the children in the control group (11 per
cent). In the first quarter 38 per cent of the children in the posture
group for whom deportment grade was reported at first and last
quarters were graded A as compared with 32 per cent of the similar
group of the control children. In the fourth quarter 54 per cent of
the same group of posture children attained grade A as compared
with 34 per cent of the control children.
The improvement in scholarship and deportment has been shown
to occur more frequently among children who ^received posture
training. Since there is no basis for the assumption that the chil­
dren in the posture group were brighter and therefore more likely
to have improved in scholarship nor that there was any other reason
for more improvement or better deportment in the posture group
than in the control, there seems to be little question that these im­
provements were associated with posture training. With posture

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

30

POSTURE AND PHYSICAL FITNESS

training there apparently follow improved health, as evidenced by
lower rates of absence from school on account of personal illness,
and improved deportment and improved scholarship, both of which
possibly reflect increased ability to concentrate on work in hand.
PHYSICAL INDEXES OF THE RESULTS OF POSTURE
TRAINING 7
VITAL CAPACITY

Vital capacity has been used, especially by cardiologists, as a fair
index of the physical fitness of an individual. Some authorities 8
have considered it dependable enough to state that anyone with as
much as 10 per cent less vital capacity than is normal for his class is
probably suffering from some health-depressing condition. If he is
as much as 15 per cent below normal it is practically certain that he
is abnormal in this respect. The question therefore immediately
presented itself as to whether a change in body mechanics affects the
vital capacity.
Other investigators have established the physiological fact that in
animals there is a constant ratio between the weight of the lungs and
the skin surface. They have also noted that in human beings, accord­
ing to sex, there is a definite ratio of vital capacity to the body surface
area, and that there is less vital capacity in the lying than in the
sitting position. But no difference in chest conformation seemed to
account for this variation.9 It was worth while then to determine
whether improvement in body mechanics, as it brought about a
more elevated chest and an increase in the anteroposterior diameter
of the chest, would thereby cause a greater expansion of the lungs
within; i. e., increase the vital capacity.
The changes in vital capacity between the first and the last exam­
ination were practically the same irrespective of whether the children
had been given posture training and also irrespective of whether they
improved in posture. The average increase in vital capacity for
posture children was 0.182 ±0.006 liters as compared with 0.188 ±
0.007 for the control children, and the average increase for the posturetrained children who improved was 0.192 ±0.008 as compared with
0.160 ±0.010 for the posture-trained children who showed no change
in posture. The study does not show that either posture training or
improvement in posture is associated with change in vital capacity.
TYP E O F R E S P IR A T IO N

In ordinary quiet respiration, without obvious effort, inspiration is
accomplished by the contraction of the diaphragm alone or by the
diaphragm together with some of the rib muscles. At the end of
J The statistical analysis in this section was made by Dr. Elizabeth C. Tandy, director of the statistical
division of the Children’s Bureau. The statistical method used is that of arithmetic average and its prob­
able error, which is placed after the average and separated from it by a plus and minus (± ). An average is
considered statistically significant if it is greater than three times its probable error. The difference be­
tween two averages is ob tained by subtraction. The probable error of the difference is obtained by squaring
the probable errors of the two averages, adding the two squared probable errors, and extracting the square
root of the sum. The result is the probable error of the difference of the two averages. This' difference is
considered significant if it is greater than three times its probable error. For example, the increase in vital
capacity for both posture and control groups (0.182±0.006 and 0.188±0.007, respectively) was significant,
each average being more than three times its probable error; but the difference between the two averages
(0.006±0.009) was insignificant, since the difference does not exceed three times its probable error.
8 Dreyer, Georges: The Assessment of Physical Fitness. Quarterly Publication of the American Statis­
tical Association, vol. 17, No. 135 (September, 1921), pp. 929-932.
8 Christie, Chester D., and Argyl J. Beams: The Estimate ofNormal Vital Capacity. Archives of
Internal Medicine, vol. 30, No. 1 (July 15, 1922), pp. 34-39.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

31

POSTURE AND PHYSICAL FITNESS

inspiration, expiration is entirely passive and is due to purely physical
forces, such as the elasticity of the expanded lungs and the elasticity of
the distended abdominal wall. Therefore, the nomenclature used in
the study for types of respiration, was based on inspiration— whether
the movement of the abdomen due to the contraction of the diaphragm
was the chief or only feature and therefore the inspiration was “ ab­
dominal, ” or whether the elevation of the ribs was the most noticeable
factor and therefore the inspiration was “ costal,” or whether the
movement was evenly balanced between the chest and the abdomen
and the inspiration was “ costal and abdominal.”
The respiration of almost all the children (98 per cent) at the first
examination was costal and upper abdominal in character. No
significant variations are shown in the percentages of the various
kinds of respiration among children of the different types of body
build. The incidence of the different types of breathing was essen­
tially the same among children having good posture and children
having poor posture.
Change in type of breathing did not strikingly accompany improved
posture, but change to the upper abdominal type of breathing was
more frequent among children who improved in posture than among
those who did not improve. This change was also more often found
among trained children whose posture improved than among the
control children who improved in posture (17 as compared with
5 per cent). (Table 8.)
T able 8.—

Change in type o f breathing and change in posture fo r children in the
posture and control groups
Change in posture
Total children
Improvement

No change

Regression

Change in type of breathing
Num­
ber

Total

Per
cent
Num­
distri­
ber
bution 1

Per
cent
Num­
distri­
ber
bution 1

Per
cent
Num­
distri­
ber
bution 1

Per
cent
distri­
bution 1

______________

1,708

Posture group________

961

100

598

100

351

100

12

Improvement______________
No change_________________
Regression_____ ______
Not reported_______________

118
770
70
3

12
80
7

104
452
40
2

17
76
7

13
307
30
1

4
88
9

11

747

100

78

100

504

100

165

100

17
691
29
10

2
94
4

4
72
1
1

5
94
1

10
466
22
6

2
94
4

3
153
6

2
94
4

Control group_____ _
Improvement__________ .
No change. ________ . . .
Regression______ ________
Not reported___________

676

855

177

=====

1 Not shown where number of children is less than 50.

When a child has attained good body mechanics and it has be­
come habitual, the chest is elevated almost to its highest point and
is practically immobile in respiration. The diaphragm is the mobile
part, and this is manifested with each contraction of the diaphragm
by the movement of the upper abdomen. The lower abdomen,
since it is held retracted in good posture, is naturally also immobile!


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

32

POSTURE AND PHYSICAL FITNESS

Quiet breathing is then mainly diaphragmatic or upper abdominal
in type in contrast to the more difficult or labored breathing which
necessitates a greater effort of the rib muscles with each inspiration.
Many of the children did not change to this upper abdommal
type of breathing as an improvement in posture took place. Per­
haps the period of observation wa^ too short for them to have ac­
quired in any great measure this more facile method of respiration
that is characteristic of good body mechanics. Experience with
children given individual and more intensive training in posture
clinics would indicate that they acquire a type of respiration upper
abdominal in character only when they have acquired excellent
body mechanics and have learned to maintain it. In the present
study the children who improved in posture showed a greater tend­
ency to acquire this almost effortless type of abdominal breathing
than did those who did not improve their posture, and, as has been
noted previously, the upper abdominal type of respiration^was much
more frequent among the children who had postural training than
among the control group.
P O ST U R E A N D C O STA L M O B IL IT Y

Quiet breathing ideally is diaphragmatic in character, and then
the inspiratory movement is manifested chiefly by movement of
the upper abdomen, due to the contraction of the diaphragm. As
soon as the breathing movements become at all forced, the action
of the other inspiratory muscles, the elevators of the ribs, come
into play. In most children, as has been seen, the tendency in nat­
ural respiration is to show a certain balance between the diaphragm
and the ribs. Only in those children that have acquired excellent
posture and the habitual maintenance of it, is the ^diaphragmatic
type found practically alone. In all others there will be a certain
degree of excursion (expansion) of the ribs with each respiratory
cycle to compensate perhaps for the inadequate excursion of the
diaphragm. Is this excursion of the ribs then different with changes
in body mechanics?
.
The question put somewhat differently is whether the rib muscles
of the child with better posture are in better tone for improved
functioning. It would seem that in the child with poor posture,
whose chest is drooped because the ribs are •drooped, the rib
muscles would be more or less relaxed and therefore not in the best
tone to effect an even excursion of the ribs. The excursion of the
ribs from neutral to full inspiration would be greater than from
neutral to expiration, for the position of the ribs at neutral would
be almost that of expiration. In other words, the chest at neutral
would be almost in a position of expiration while with improved
posture the ribs would be more elevated in the neutral position and
from it the excursion to full inspiration would be more nearly equal
to that of full expiration. The circumference measurements of the
chest at the level of the axilla and xyphoid cartilage, and the depth
measurements of the chest at the level of the xyphoid were taken
at neutral, full inspiration, and expiration for each child, to answer
this question.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

33

At the first examination less than 2 per cent of the children showed
an even spacing of the circumference readings between neutral and
inspiration and neutral and expiration, at either the axilla or the
xyphoid, and only 11 per cent showed an even spacing of the depth
reading at the xyphoid. The difference between the measurements
at neutral and at inspiration was greater than the difference between
the measurements at neutral and at expiration. This difference was
greater at the axilla of 93 per cent of the children, at the xyphoid of
97 per cent, and in the depth at the xyphoid of 87 per cent. The
first examinations showed no relationship between posture grade and
difference in respiration readings because the posture was almost
uniformly poor. But with improvement in posture a more nearly
even excursion of the ribs was shown in many cases. The records of
598 trained children, whose posture improved, showed at the end of
the school year that the differences between respiration measure­
ments at inspiration and neutral, and between neutral and expiration
were more nearly equal than at the beginning of the year in 51 per
cent of the children for circumference at the axilla, in 38 per cent for
circumference at the xyphoid cartilage, and in 40 per cent for depth
at the xyphoid. From this it would seem logical to conclude that
with improvement in posture comes elevation of the ribs, so that at
neutral they are no longer dropped almost to the position of expira­
tion, and with respiration, the rib muscles, in better tone at neutral,
are more adapted for an even excursion of the ribs and therefore a
steady, even aeration of the lungs.
TYP E OF R E T R A C T IO N

The position of an individual's abdominal wall, particularly the
lower part, is one of the indexes of his posture. If the lower abdominal
wall is retracted and flat, it indicates a certain degree of good posture.
If, however, it is relaxed and protuberant, it indicates poor posture.
In fact, good body mechanics, as taught to the children of the posture
group in the present survey, depended on abdominal retraction as one
of the fundamentals to be learned. Of course, for a certain period at
least, fairly good posture can be maintained without abdominal retrac­
tion. In most cases, however, this posture will be one of strain. As
a rule, abdominal retraction is essential for the maintenance of good
body mechanics, and the ability to retract the lower abdomen easily
and directly is an indication of the development in the individual of
his sense of muscle position.
Only 4 per cent of the children at the first examination were able to
retract their abdomens directly when asked to do so. (Table 9.)
About one-fifth (19 per cent) of the children contracted their abdominal
muscles slightly, but effected retraction primarily by elevating their
chests. Approximately three-fourths (77 per cent of the children)
retracted indirectly by pulling up their chests and with them their
abdominal walls. Though they were merely asked to draw in their
belly walls, most of the children had such a poor sense of position of
their abdominal muscles that they apparently found it easiest to use
their intercostal muscles to elevate their ribs, and in this way by indi­
rect pull on the abdominal wall upward, to effect its retraction. Their


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

34

POSTURE AND PHYSICAL FITNESS

abdominal muscles generally protruded relaxed, serving as a sort of
retaining wall. When called upon to retract them, the individual
naturally responded by using the accessory respiratory muscles, mus­
cles he was more accustomed to using. This form of retraction could
be continued only for a short period-—as long as the strain could be
endured or the breath could be held.
T able 9.—

T yp e o f retraction and posture grade at first examination fo r all children
included in the study
Posture grade
Total children
C

A and B

Type of retraction at first
examination

D

cent Num­ Per cent Num­ Per cent Num­ Per cent
Num­ Per
distri­
distri­
distri­
distri­
ber
ber
ber
ber
bution
bution
bution
bution
133

1,708
Total reported........ ..............
Abdominal_____________
Abdominal and costal___
Costal_________________

1.039

536

1,706

100

133

100

1,037

100

536

100

70
328
1,308

4
19
77

19
40
74

14
30
56

37
207
793

4
20
77

14
81
441

3
15
82

2

2

Type of body build seemed to have little influence upon type of retrac­
tion, for 75 per cent of the thin children, 76 per cent of the intermediate,
and 79 per cent of the broad children retracted their abdomens indi­
rectly by pulling up their chests. Among children receiving different
posture grades, however, there was variation in the incidence of the
different types of retraction. Costal retraction was found most fre­
quently in each type, but direct abdominal retraction was performed
by 14 per cent of the children graded A and B as compared with 4 per
cent of the children graded C and 3 per cent of those graded D .
Abdominal retraction became more prevalent with posture training,
for it was one of the first things taught. B y the end of the school
year 70 per cent of the trained children retracted their lower abdominal
wall immediately when asked to do so, in contrast to the 4 per cent of
these same children who did so at the time of the first examination.
Improved retraction was most frequent among children who improved
their posture under training, for 93 per cent of these children had better
retraction at the end of the school year. (Table 10.) Even those who
did not improve in posture under training for the most part learned
abdominal retraction. (Table 11.) As has been shown, the length
of training necessary to improve a child’s posture varies, and it may
very well take more than one year to effect the improvement. But
the fact that 70 per cent had learned abdominal retraction by the
end of the school year shows that they had learned at least one of the
fundamentals of good posture.10
i®The other fundamental requirements of good posture are back with normal curves, chest held up, and
head up with chin in. See Posture Exercises, p. 2 (U. S. Children’s Bureau Publication No. 165, Washing­
ton, 1926).


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

35

POSTURE AND PHYSICAL FITNESS

T able

1 0 .— Change in type o f retraction and change in posture for children in the
posture and control groups

Change in posture
Total children
Improvement

No change

Regression

Change in type of retraction
Num­
ber

Per
cent
distri­
bution

Num­
ber

Per
cent
distri­
bution

Num­
ber

Per
cent
distri­
bution

Num­
ber

Posture group________

961

100

598

100

351

100

12

Improvement______________
No change___ _ ___ ____
Regression._____
________

819
132
10

85
14
1

559
38
1

93
6

255
88
8

73
25
2

5
6
1

Control group________

747

100

78

100

504

100

165

Improvement______________
No change______ ____ ______
Regression_______ _____ ____
Not reported_______________

113
525
103
6

15
71
14

15
53
9
1

19
69
12

78
349
74
3

16
70
15

20
123
20
2

(*)

1 Not shown where number of children is less than 50.

Per
cent
distri­
bution 1

100
12
75
12

2 Less than 1 per cent.

T able 1 1 .-— T yp e o f retraction at second examination and change in posture for
children in the posture and control groups

Change in posture
Total children
Improvement

Type of retraction at second
examination
Num­
ber

Per
cent
distri­
bution

Num­
ber

No change

Per
cent
distri­
bution

Num­
ber

Per
cent
distri­
bution

Num­
ber

Posture group________

961

Total reported..................... .

961

100

598

100

351

100

12

676
218
67

70
23
7

489
97
12

82
16
2

181
118
52

52
34
15

6
3
3

Abdominal__________ ..
Abdominal and costal___
Costal_________________

598

Regression

351

Per
cent
distri­
bution 1

12

Control group.......... .

747

Total reported___ ____ _____

743

100

77

100

502

100

164

100

Abdominal_____________
Abdominal and costal___
Costal_________________

58
122
,563

8
16
76

8
9
60

10
12
78

41
85
376

8
17
75

9
28
127

5
17
77

Not reported.....................

78

4

1

504

2

165

1

1Not shown where number of children is less than 50.

The untrained children of the control group showed much less fre­
quent change in manner of retraction after one year’s observation.
Improvement in retraction with them took place in only 19 per cent
of those whose posture improved in contrast to the 93 per cent of the
trained children who improved. To be sure, only 10 per cent of the


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

36

POSTURE AND PHYSICAL FITNESS

control group improved in posture and in the main only from a bad
posture to a type merely not so bad. The small percentage that had
abdominal retraction with their better posture indicates that they
held the improved posture by contracting the intercostal rather than
the abdominal muscles. They had not learned as yet to realize the
position, the existence as it were, of their abdominal muscles. They
still lacked the control of these abdominal muscles that the posture
children had acquired with their training.
Most of the posture children had learned to acquire a sense of the
position of their abdominal muscles and had attained conscious con­
trol over them. They had progressed definitely toward the ability
to keep their lower abdomens retracted continually. If they con­
stantly maintained this position, their abdominal organs were held up
to the position in which they belonged. Mankell and Koenig have
shown that abdominal viscera which have sagged because of relaxed
protuberant bellies can be elevated 1 to 6 inches by simple retraction
of the lower abdominal wall.11 Of this type of retraction most of the
children of the posture class (70 per cent) had acquired conscious
control. With practice these children would acquire the subconscious
habit of continuous retraction and so be on the way to gain the physio­
logical benefits that come from properly supported and properly
placed abdominal organs.
C IR C U M FE R E N C E A N D D E P T H OF A B D O M E N

The abdominal wall is one of the sites in the human body for the
deposition of excess fat. A certain amount of fat is of course not to
be despised; but when it occurs in excessive quantities, it is at least
questionable whether this is advantageous. Such deposits are at
best a burden to carry, and in the abdominal wall they are a fairly
good index of the degree of relaxation of the abdominal muscles. Of
course such relaxation may occur unassociated with fatty deposits.
In children, however, there are usually varying amounts of fat depos­
ited in the belly wall associated with abdominal-muscle relaxation.
This was shown by the effect on the circumference and depth measure­
ments of the abdomen of abdominal retraction, which plays a very large
part in improving posture and in posture training.
Before any training was given, the average circumference of the
body around the abdomen, at the level of the navel, was slightly
greater for the posture group (25.42 ±0.071 inches) than for the
control group (25.01 ±0.077 inches). At the end of the school year
the average circumference for the posture group was 25.07 ±0.073
inches as compared with 25.13 ±0.076 inches for the control group.
The control children, although there was a period for growth and
perhaps also in many cases increase in fat in the belly wall and in­
crease in relaxation of the belly muscles, showed no significant
change in circumference measurement ( + 0.117 ±0.108^inches) during
the school year. The posture children, however, in spite of the same
increase in growth, significantly decreased in average circumference
( —0.350 ±0.102 inches). Throughout the year they had practiced
ii Mankell, Nathalie K., M . D., and Edward C. Koenig, M. D.: Posture and Types of Breathing. New
York Medical Journal, vol. 104 (July-December, 1916), p. 938.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

37

retraction of the lower abdomen in the effort to improve their posture.
They had exercised the abdominal muscles and had thereby decreased
their relaxation. The fatty deposits in the abdominal wall had ap­
parently been reduced as the posture improved, for the average
decrease in circumference of the abdomen among the trained chil­
dren whose posture improved was 0.464 ±0.128 inches. This de­
crease must have been associated with training as well as improve­
ment in posture, for there was no change whatsoever in the average
circumference of abdomen among the control children whose posture
improved and no significant change among posture children who
received the same posture grade at the first and last examinations
( —0.171 ±0.173 inches). These trained children whose posture grade
did not improve probably increased the tone of their abdominal
muscles enough with continuous practice of abdominal retraction so
that they had somewhat less relaxation of the abdominal muscles
when they stood naturally.
The depth of the abdomen at the level of the navel showed changes
in measurement which reflected training and improvement in posture.
Although the average depth of the abdomen increased among both
posture children ( + 0.081 ± 0.012 inches) and control children ( + 0.140
±0.013 inches), the average increase was less in the posture-trained
class than in the control class (the difference between the two
averages being +0.059 ±0.018 inches) and was also less among
those in the posture class whose posture grades improved ( + 0.049
±0.015 inches) than among those in the posture class whose posture
grades did not improve ( + 0.135 ± 0.020 inches). (Difference between
the two averages was +0.087 ±0.025 inches.)
The lack of decrease in depth of abdomen after posture training
indicates clearly that the children did not stand with their abdomens
retracted while they were being measured; for if they had done so
generally there would have been an average decrease in depth.
They probably stood in the same manner for circumference measure­
ment of the abdomen, as this was part of the same examination.
This latter measurement showed a definite decrease with posture
training and especially with improved posture. Since there was
no decrease in depth, the lower abdomen could not have been re­
tracted at the thne of examination. Since the decrease in circum­
ference of the abdomen could not have been due to retraction of
the abdomen, it must have resulted from the reduction of fat in
the belly wall which was associated with improved tone of the ab­
dominal muscles following posture training.
B R E A D T H OF C H EST

The breadth of the. chest at the level of the xyphoid cartilage
did not change appreciably with changing posture. There was a
slight average increase in breadth among both posture children
( + 0.239 ±0.007 inches) and control children ( + 0.231 ±0.008 inches),
but the difference in the increases was insignificant. In the posture
group the average increase was practically the same whether the
children improved in posture ( + 0.238 ±0.009 inches) or showed no
change under training ( + 0.239 ±0.012 inches),


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

38

POSTURE AND PHYSICAL FITNESS
T H E C O STAL AN GLE

The costal angle is that angle formed by the margins of the lower ribs
in front at their junction with the xyphoid cartilage. This angle was
measured, as has been described, at each examination at neutral and
also at full inspiration.
The costal angle, it had seemed from experience gained from working
with individuals and in posture clinics, was a good index of the degree
of relaxation and drop of the chest. The angle apparently was
smaller as the ribs dropped lower and nearer together. The size of the
costal angle also seemed to be associated with the type of body build.
The thin type apparently had the smallest angle and the broad type
the largest. Study of the measurements obtained in the examination
of the children in the present study partly confirmed these impressions.
The costal angle at neutral was found to vary with type of body
build, the average angle being much larger for the broad type (71.791°
± 0.444°) than for either the intermediate (67.718° ±0.297°) or the
thin type (66.087° ± 0.653°), which were essentially the same. The
average costal angle at neutral of children with good posture (72.586°
± 0.744°) was found to be significantly greater than that of children
with poor posture (68.137° ±0.245°). In this connection it must be
remembered that the children of the broad type more frequently had
good posture prior to training than children of either the thin or the
intermediate type. One type, however, did not improve under train­
ing more frequently than another. Posture training had no obvious
influence upon the average size of the costal angle at neutral. The
average change in the angle among trained children who improved in
posture (+1.462° ±0.527°) was insignificant, and that for trained
children who retained the same posture grade throughout the year
( + 0.861° ±0.660°) was similarly insignificant.
The average costal angle at inspiration at the first examination was
similarly found to be greater for children with good (A and B) posture
(90.677° ±0.740°) than for children with poor (C and D ) posture
(86.889° ±0.222°). The average angle at first examination for chil­
dren of the posture group (87.381° ±0.282°) was similar to that of
children of the control group (86.935° ± 0.324°) and to that of children
of the posture group who improved during the year (86.884° ± 0.363°).
At the end of the year the average angle at inspiration was found to
have increased for each of the groups just mentioned. The aver­
age angle at the second examination for the control children was
91.230° ± 0.259°, that of the posture group was 95.386° ± 0.235°, that
of the posture children who improved was 95.713° ± 0.298°, and
that of the posture children who showed no change in posture was
94.730° ±0.388°. The average increase in the angle for the posture
group (8.005° ± 0.367°) was considerably greater than the average in­
crease for the control group (4.295° ± 0.415°). The average increase for
the posture children who improved in posture (8.829° ±0.470°) was
greater than that of children in the control group whp improved
(3.346° ± 1.234°) but not significantly different from the average in­
crease of posture children who made no change in posture (6.669° ±
0.599°). The average increase in this last-mentioned group was
greater than that of either the total control group or those in the
control group who improved.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

39

A certain amount of increase in the costal angle at inspiration is
obviously due to growth. The average increases in the angle, however,
are considerably greater for trained children than for untrained. The
greatest increases are associated with the training process rather
than postural improvement.
B IAC R O M IA L D E P TH

The distance between the two acromion processes of the shoulders
has been offered as an anthropometric measurement suitable for use
in the study of body-surface area. This measurement varies slightly
with respiration, being greater when taken at full inspiration than at
the neutral point of respiration. Since with improvement in posture
there is a certain amount o f elevation of the chest, it was pertinent to
determine whether the change in elevation associated with better
posture brings a change in the reading of the biacromial-depth meas­
urement.
The distance between the two acromion processes changed in 86 per
cent of the children observed during the period of one school year, and
in 81 per cent the change was an increase. Increases were for the
most part comparatively small. More than two-thirds of the children
who increased in this measurement, increased less than an inch.
This change was probably associated with growth. It was evidently
not related to change in posture, for no significant differences ap­
peared between the average increase in the posture group (0.596 ±
0.013 inches) and the control group (0.573 ± 0.013 inches), nor between
the average increase of the trained children whose posture improved
(0.616 ± 0.017 inches) and the trained children whose posture remained
unchanged (0.562 ±0.018 inches). The biacromial measurement is
apparently not affected to any significant degree by posture training
or change in body mechanics.
PO STU R E A N D P R O N A T IO N

The mechanics of the feet are good when a perpendicular dropped
through the knee joint, as the child stands, will pass through the
ankle and meet at right angles another line passing through the
foot from a point between the first and second toes in front, to the
middle of the heel in back. If the forefoot is turned outward from
the median axis of the body the condition is spoken of as abduction.
If the entire foot is rotated outward on a horizontal axis, it is con­
sidered everted. A combination of such eversion and abduction is
meant by the term pronation. Pronation is therefore a form of
poor statics of the feet, an evidence of poor mechanics in that part
of the body. There are, of course, different degrees of pronation.
All degrees were grouped in the findings of the examination.
Pronation was present in about four-fifths of the children observed,
and it was definitely most prevalent among those children who had
the worst posture and less prevalent among the children with better
posture. Those who had the best posture had the lowest percentage
of pronation. The children with a thin type of body build showed
pronation more frequently than those of the intermediate or broad
type. Nutrition also seemed to be related to pronation for there
was less pronation among the well-nourished children.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

40

POSTURE AND PHYSICAL FITNESS

These conditions must not be considered as the only vital factors
influencing the statics of the feet, for shoes, overuse, and strain are
also important factors. It is interesting, nevertheless, that both
nutrition and body mechanics in general, which were shown to be
definitely related to each other, apparently are also related to me­
chanics of the feet. One would, naturally expect poor foot statics
to be associated with generally poor body mechanics. Therefore it is
not at all surprising to find that 78 per cent of the children examined
showed poor mechanics of the feet and 93 percent of them had generally
poor body mechanics.
SC O LIO SIS

Scoliosis, or lateral curvature of the spine, was noted when pres­
ent. It was considered to be functional or habitual in character
if it disappeared in the forward-bend position; i.e., when the child
bent forward from the hips with the hands lowered toward the
ground; or, if there was no posterior convexity of the ribs in back
m this forward-bend position—no hump, the sign of bony rotation
m the spinal segments. The scoliosis was considered structural or
fixed, on the other hand, if the evidence of bony changes in the
spine mentioned above were present. The curves were named right
or left according to their convexities— curves convex to the right
bemg called right curves, and vice versa.
Scoliosis was found at the first physical examination in 78 (5 per
cent) of the 1,708 children. It was structural or fixed in 4 cases
and functional or habitual in 74. Of these functional cases, 45 were
left curves, 22 were right, and 7 were mixed or split curves with
part of the deviation to the right and part to the left. Thirty-eight
of the functional-scoliosis cases were in the posture group and 36
in the control group.
Posture training evidently had considerable effect upon functional
scoliosis. Of the 38 children in the posture group who had this
type of scoliosis at the first examination, 27 had straight spines at
the second examination. Of these 27 children 25 at the same time
had improved their posture. In contrast, only 9 of the 36 control
cases had rid themselves of their scoliosis, 6 of these 9 having im­
proved in posture.
Habitual scoliosis was found, at the second examination, in 30
children who did not show signs of it at their original examination,
but only 1 case of such scoliosis developed in the posture group
whereas 29 appeared in the control group.
Posture training, therefore, through improvement in posture in
tne majority of cases overcame habitual lateral curvature of the
spine. It served also as a specific prophylactic measure against
the development of such lateral curvature.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

SUMMARY
The following conclusions in regard to the effect of good body
mechanics on the health and efficiency of grammar-school children are
based on experience with 1,708 children in the Williams School at
Chelsea, Mass., whose records were adequate for analysis. The
posture group included 961 children who were given training in proper
body mechanics. The control group included 747 who were not
given any posture training. In all other respects the school work of
the posture and control children was similar. The two groups were
similar at the first examination in respect to age, sex, nationality, and
posture grade and various physical indexes.
At the first examination most of the children had poor body mechan­
ics. Judged by the standards of body mechanics used in the study,
more than 90 per cent of all observed had poor posture, the boys rank­
ing somewhat better than the girls. Good posture was more preva­
lent as the children grew older, but poor body mechanics was not
outgrown to any marked degree. At least 80 per cent of the children
in each age period had poor posture. The children of the broad type
of body physique had the largest percentage of good posture, and those
of the thin type had the largest percentage of poor posture.
The prevalence of poor body mechanics was strikingly reduced by
posture training. During the period of observation six children in
the posture class improved in posture to every one of the control
children who improved. With adequate training 60 per cent of chil­
dren above the first grade in school can be expected to improve in
posture during a year’s training, irrespective of age. The older
children grasped the principles more quickly and improved more
frequently, but improvement was manifest at all ages. Improvement
can be eventually expected in nearly all children, but some require
longer training than others. Good posture once acquired was main­
tained, on the whole, over the 2-year period of observation by the
children who received two years of posture training.
Improvement in body mechanics was associated with improvement
in health and efficiency. More of the children who started with poor
posture, when given training, improved their nutrition when they
improved their posture than did those who did not improve their pos­
ture. Improvement in posture was found to occur more frequently
with training if there was improvement in nutrition as well. Among
the children without posture training, improvement in posture oc­
curred more frequently with those in the best nutritional condition.
Training was the most essential factor in the acquisition of good body
mechamcs, and good body mechanics was associated in a small pro­
portion of the children with improved nutrition. Since nutrition has
been accepted as an important index of a child’s health, posture
training would seem to be an important factor favorable to health,
as indicated by its association with improved nutrition.
41


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

42

POSTURE AND PHYSICAL FITNESS

Improvement in body mechanics was also associated with improve­
ment in school work. The rate of absence due to personal illness
decreased in children who received posture training until it was
considerably lower than that of untrained children. The posturetrained children also showed more improvement in deportment than
the untrained children. The percentage of children who improved in
scholarship was higher among the trained children than among the
untrained.
Posture training had no significant effect on the changes that oc­
curred in the vital-capacity readings. Changes of this character were
undoubtedly associated with growth.
A tendency toward the upper abdominal type of breathing was mani­
fest with better body mechanics. A more even excursion of the ribs
in respiration and therefore a greater possibility of better aeration of
the lungs was also noticeable.
Retraction of the lower abdomen, on request of the examining physi­
cian,was effected by direct retraction as a rule only by children with
good body mechanics. Posture training and better posture brought
an improved sense of muscle position and, therefore, improved ability
of direct retraction of the lower abdomen. This ability is of value in
that, with practice, the retraction of the lower abdominal wall becomes
habitual and steady. The result of this practice is the elevation of the
stomach, intestines, and other abdominal organs. Posture training is,
therefore, a safeguard against visceroptosis, which is frequently associ­
ated with poor health.
Posture training improved the tone of the abdominal muscles and
reduced the fat deposited in the abdominal wall. This was indicated
by decrease in the circumference measurement of the abdomen without
decrease in depth. The effects of posture training, however, are not
to be considered as merely reducing in character; for while improved
posture is associated with a decrease in abdominal girth, there is also
at the same time, in a certain proportion of cases,improvement in the
general nutritional condition.
Posture training and improvement in posture had no apparent effect
on the breadth of the chest at the level of the xyphoid cartilage, nor
on the distance between the acromion processes of the shoulders.
The size of the costal angle varied with type of body build, being
smallest for the thin type and largest for the broad type. Change in
the angle at neutral and change at inspiration came with growth, but
the average increase in the angle at inspiration was greater for trained
children than for untrained.
About four-fifths of the children observed had pronated feet. This
condition was most frequently associated with poor body mechanics.
It was more frequent among children of the thin type and was less
frequent among children with good nutrition.
Postural, habitual, or functional lateral curvature of the spine
(scoliosis) disappeared generally with improvement in body mechanics.
Posture training was an aid in the correction of habitual scoliosis and
also served as a specific prophylactic measure against scoliosis.
In conclusion, it seems desirable to recall the purpose of the study.
Physicians and physiotherapists who have had experience with posture
training have been generally convinced that such training is beneficial
to health, nutrition, and morale and that the favorable influence of the
training persists as long as the correct posture is maintained. Careful

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

POSTURE AND PHYSICAL FITNESS

43

reviews made of small numbers of cases have shown correct posture
once attained to be fairly permanent. Hitherto, however, it had
seemed impracticable, if not impossible, to provide this expert train­
ing for the average school child.
In this study the attempt was made to ascertain: (1) Whether
the average school-teacher and the average school director of physical
education, having been taught the rudiments of good posture, could
impart the general principles to the school children without disorgani­
zation or undue increase in curricular work. This study shows that
these members of the regular school staff are able to give the children
posture training which they have learned from experts without undue
rearrangement of the school activities. (2) Whether such training in
good posture carried out during the period of one school year would
bring greater evidence of improved health, nutrition, and morale
among the children who were trained than among a control group
receiving no posture training. Analysis of the records shows that
favorable results may be attributed to the posture training. Posture
training and the maintenance of correct posture contribute to the
health and efficiency of normal grade-school children.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

44

POSTURE AND PHYSICAL FITNESS

APPENDIX.— PHYSICAL-EXAMINATION SCHEDULE USED IN
POSTURE STUDY
Field No........... ............................................ .......................................... ...........................Office No. .........
1. N am e......................................... —— 2. Address.....................iiJ
3. (a) W. B. O.: N. F. (spec.) ................................ ...
4. Sex: M . F. ...................... .............

Physical examination

City . . .

*

.............

(&) Mother: N. F. (spec.)

5. School............................. — 6. Grade...
II

I

III

IV

V

7. Date of examination. .............. Y -.m .-d ___ Y -.m .-d ___ Y ..m ..d ___ Y -.m _ .d -— Y -.m .-d ___
8. Date of birth-------------- --------

Y ..m ..d ___ Y ..m ..d ___ Y ..m .-d ___ Y -.m .-d .... Y -.m .-d ___
Y -.m ..d ___ Y -.m .-d ___ Y -.m .-d ___ Y -.m .-d ___ Y ..m ..d ___
................in. ..1 ...........in. ................in.
.

...............lbs. ........... ..lbs.

lbs.

................ lbs.

12. Underweight---------------- ----- ....l b s .— % . . . _lbs.— % . . . .l b s ....% — lbs.. . . % — lbs........%
VI

V II

V III

IX

X

7. Date of examination.............. Y ..m ..d ___ Y ..m - .d ___ Y -.m .-d ___ Y -.m —d___ Y -.m .-d ___
Y -.m .-d ___ Y -.m .-d ___ Y -.m .-d ___ Y -.m .-d ___ Y -.m .-d ___
9. A ge................................. .......... Y -.m .-d ___ Y -.m .-d ___ Y -.m .-d ___ Y ..m ..d ___ Y__m .-d___
................in. ................ in. .............. .in. .................in.
..............lbs.

..............lbs.

...............lbs. ........... — lbs.

12. Underweight---------------------- ....l b s .— % . . . .l b s ....% . . . .l b s ....% . . . .lbs.— % . — lbs........%
13. School attendance:
14. Absent for—

Past

I

II

III

IV

(a) Infectious diseases (specify).. Yes, No____ Yes, No____ Yes, No____ Yes, N o.. .. Yes, N o.. . .

(h) Holds

......... ...................

Yes, No____ Yes, No____ Yes, No____ Yes, N o.. .. Yes, No____
Yes, No____ Yes, No____ Yes, No____ Yes, N o.. .. Yes, No____
Yes, No____ Yes, No....... Yes, No____ Yes, No____ Yes, No____
Yes, No____ Yes, N o ___ Yes, No____ Yes, No____

Yes, No.......
(Spec, how often cathartic
taken.)
15. Medical work by outside
agencies.

Yes, N o.. .. Yes, No____ Yes, No____

Yes, No....... Yes, No____ Yes, No____ Yes, N o____ Yes, No____

-


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

45

POSTURE AND PHYSICAL FITNESS

APPENDIX.— PHYSICAL-EXAMINATION SCHEDULE USED IN
POSTURE STUDY— Continued
18. Grade A. B. C. D.
19. Teacher............ ................... ......

20. Assistant......... ...........................

21. Group.............................

22. Diagnosis:

Physical examination
23. Date.............. ........... ......

I

II

.

24. Appearance........................ ...........

A. B. C. D.

A. B. C D

25. Type......... ......................... ........
26. Standing position................... ........
27. Gen. (phys. exam.), specify______

28. Pronation.... ..........................
29. Abduction....................... ........
30. Breathing___ _______ ________

Cos. Up. Abd., Low. Abd. ~ Cos. Up. Abd., Low. Abd__

31. Retraction..........................
Circum ference —

32. Abdomen at navel_______
33. Axilla: (a) Neutral___ _
(6)

Inspiration_____ . . . _

(c) Expiration- ________
34. Xyphoid:(a) Neutral________
(6)

Inspiration________

(c) E xpiration.................
D epth —

35. Interacromial— .........
36. Xyphoid: (a) Neutral____
(6)

Inspiration........ .

(c) Expiration________
37. Abdomen: (o) Normal____
(6)

Retracted________

38. Breadth of chest at xyphoid___
39. Vital capacity............ ......

iu « r

40. Costal angle____ ________
41. Examined by___________
42. Photographed by...............

0


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis