An explanation of The Posture Theory diagram

© designed in 1980

The parts of the diagram

The Posture Theory diagram summarises an idea that took five years to develop (between 1975 and 1980) and it aims to give an instant, and reasonable understanding of the concept.

It depicts a man sitting at a desk and leaning forward to read.

The left side of the diagram contains straight dashed lines and a curved line which show the movements that occur when leaning forward, and the external pressures that are created.

The large dot in the middle represents the position just below the tip of the breastbone, and is like an axle about which the upper body rotates when the person leans forward and backward while slouched at the waist.

The lines inside the man are there to give an impression of the way mechanical pressure affects internal structures as he leans forward.

The column of words on the right side show the sort of symptoms that can result.

The angles of pressure

The vertical line in the middle represents a position parallel to the spine when the person is sitting upright. The next line to the left of it represents the distance that a particular individual leans his head and shoulders forward if he has a stooped spine or a slouch. The angle between the two lines is called the stoop angle.The next line represents the extra distance he would lean forward to get his eyes close enough to a page so that he could read the text. He will naturally sit up after he has read the text, and lean forward when he needs to read or write again, so it is called the angle of oscillation, i.e. the angle made as he repeatedly leans to and fro about that axis. The final line from the axis to a position in front of his feet is used to show how much relative pressure is created by leaning forward. It is an inverse angle because the worse a persons stoop, and the more they lean forward, the greater the pressure, and the smaller that angle will be. Another way of determining the amount of pressure could be to add the stoop angle and the angle of oscillation, in which case the larger the angle, the greater the pressure.

The list of symptoms in the diagram

The words to the right of the man in the diagram above show the various effects of postural pressure on the spine and internal organs, starting at the top with "distortion of sinus cavities and ducts". When the head is upright and the neck is vertical the air passes freely through the nose and down the windpipe. However any forward or backward bending of the neck alters the angles and pressures at the top of the throat and disposes to inflammations and swellings, and congestion of the ducts or tubes in that area, such as nasal congestion. The distortion is more pronounced when the neck is stooped forward, and the person lifts their head to talk to someone directly in front of them.

Similarly with the spine bent forward the neck pushes the lower jaw bone forward, which in turn pushes the lower teeth forward against the upper teeth which is a type of 'clenching' of the teeth that can cause deformities to the shape and position of the teeth, especially in growing children. It can also cause tenderness in the gums and strain on the jaw joint which may result in referred pains to parts of the face.

When the spine is stooped forward and the is head tilted up and back the extra bend in the neck puts abnormal pressure on the discs in the middle section of the neck, and strains the muscles, ligaments, and nerves in that area, which disposes to neck ache and possibly contributes to headaches. The middle bones of the neck also push forward which stretches and compresses the front of the throat, and disposes to tenderness or sore throat and colds. The forward and, or backward movement also affects the larynx or 'voice box', and can cause voice problems, as in hunchbacks who tend to talk in a husky fashion. That pressure can also affect other structures such as the Eustachian tubes which lead to the ears, and, the valve like junction which separates the foodpipe from the windpipe.

(You can slouch forward, and then move your own head forward and back to feel some of the effects temporarily for yourself, and try pushing your head all the way back until you can feel the pressure under the back of your head, and the stretching of your throat, and then push your chin down and back toward your neck until you can feel the pressures at the top of your throat. It won't become a problem unless you have a permanent stoop, or constantly sit in an unhealthy slouched position).

More obviously, when the shoulders are slumped forward they go over and above the chest causing the weight of the head and shoulders to press down on the cavity in the chest, which contains the heart, lungs and breathing muscles. The pressure on the heart can make the heartbeat more easily felt and dispose to palpitations, and pressure on the breathing muscles can cause them to cramp, and also impair the upward movement of the diaphragm so that the breathing requires more energy and is shallower and less efficient. The shallow breathing can cause a stagnation of some of the air in the lobes of the lungs and dispose to lung infections.

(You could gain some understanding of this by forcing yourself to do deep breaths while you are in a relaxed upright posture, and then when you are in a forced slouch, and feel the differences i.e. when you are sitting upright, and you inhale, your diaphragm will rise up into your chest and your chest will expand outwards, but when you are in a forced slouch your diaphragm will rise to your lower ribs and stop. You will then feel upwards and outwards pressure in that area, and your upper abdomen will expand outwards, but your chest won't move).

The pressure on the air in the chest can act like a tourniquet and impede the flow of blood from the feet to the heart, and through the chest to the brain to cause difficulty concentrating, or thinking, faintness, tiredness, and fatigue.

The forward movement of the head also pushes the weight of the shoulders over and above the twelve sets of ribs at the front of the chest.

That pressure puts strain on the structures between them, which become tender, especially between the lower ribs of the right side, but sometimes on the left and in other areas. The person may not be aware of any soreness unless they press on the tender spots with their fingers, or unless they get occasional sharp stabbing pains in those areas (like a pinched nerve).

The forward position of the shoulders can also dispose to mild or severe cramps in the muscles at the far left and right side of the chest.

The chest also contains a breastbone in front, which has the shape of a broad dagger with a blunt tip. In people with flat chests who lean forward from the waist (instead of the hips) the broad part presses backwards and compress the heart, lungs, and air in the chest, which increases the effect of the downward pressure from the shoulders.

The tip of such a breastbone would also press into the general area where the foodpipe joins the stomach, which can affect the efficiency of the valve like structure between them and cause some backflow or reflux of stomach acid. The upward flow of acid can make the inside of the foodpipe sore and tender, and the pressure and irritation can cause spasm of the junction which is called esophogeal achalasia (more accurately a failure of that section to relax properly).The tip of the breastbone also stabs into the area of the solar plexus which is a bundle of nerves that controls many abdominal functions.

The forward leaning also pushes the lower ribs downwards to press on the colon which is a long tubular structure that carries food residue from the stomach to the rectum. A section of that tube goes up the left side of the abdomen, across the top, and down the right side. The lower ribs tend to press on the bends on the left and right side, and in other sections to impair the flow of material which disposes to irregularity, constipation, and spasm of the colon, and to blockage of the appendix and appendicitis, and to the formation of small pressure ruptures or pouches in the colon wall called diverticula, which may become infected to cause diverticulitis.

The rounded curve of the back also places strain on the muscles of the mid spine, and pressure on the kidneys which filter used blood to produce clean blood and urine. Pressure on the kidney can impede the blood flow and the filtering process and may be a cause of an excessive concentration of salts which results in kidney stones. Pressure on the adrenal glands which sit on top of the kidneys may contribute to unstable or high blood pressure and an irregular or excessive output of adrenalin, and general secondary irritability of the nervous system.

When sitting upright the weight of the head and chest is transferred evenly down the bones of the spine, but when leaning forward the muscles of the lower spine are stretched, and take some of the weight, which disposes to aching in the lower back.

Treatment: The most practical and effective way of relieving all of those symptoms, which I developed gradually over a period of thirty years, was to go from a sitting and writing position, to standing and typing at a computer, with the keyboard at waist height, and the screen at eye height, so that it isn't necessary to lean forwards. See here. Other practical and useful methods which I studied and used are discussed elsewhere on this website. e.g. see here M.B.

A reference for the measurements of pressure on internal cavities: On November 5th 1887 The New York Medical Journal included a study of scientific measurements of the pressure created on the internal anatomy by corsets and posture. Some relevant information can be seen by scrolling down to Figure 15 here http://en.wikisource.org/wiki/The_Corset

Female movie stars will often report how breathless and exhausted they were when wearing corsets as part of their role in movies about nineteenth century society, and they report how glad they were to get out of the corset so that they can breath properly again.

Some more experiments to test the effects of postural or other mechanical pressures on the human body:

You could try breathing while a belt is strapped tightly around your waist or chest, or your could try wearing a tie around

your neck which is extremely tight, or you could put a blood pressure cuff on your arm and pump it up with air until the flow of blood to your hand stops and you start feeling a sensation of pins and needles in your fingers, or you could apply a very tight garter, or a tight rubber strap around your leg. Prolonged use of leg garters can cause varicose veins.

As you can appreciate, if tight collars can block blood flow through the neck , and tight garters can block blood flow to and from the feet, then tight belts, girdles, or corsets around the waist can block blood flow between the feet and the brain, and postural pressure on the abdomen can have the same effect.

When doing the experiments described in this essay, bear in mind that the effects will vary from person to person because the shape of the spine and the shape of the chest will determine the angles of pressure and the effect on your body. Such differences are discussed in more detali in other parts of this website.

Types of posture ©

1. Good posture involves an upright spine with slight natural forward curves in the neck and lower spine, and broad and straight shoulders. Significant increases in the curves or other changes in shape are listed below.

2 . Poor posture is the term used to describe an abnormal forward curve in the upper spine due to slouching while standing, and a C-shaped curve along the entire spine which can be seen from the side when a person slouches forward in the sitting position. Hence it is often referred to as the slouched posture.

3 . Kyphosis is a more extreme forward curvature of the upper spine and is due to an abnormality in the structure of the spine and is generally referred to as the hunchback posture. It is usually accompanied by a corresponding forward curve in the lower spine so that it looks like a reverse S-shape when seen from the side.

4 . Scoliosis is the medical term for sideways curvature of the spine which usually results from a person using one hand to do most of their tasks because most people are either left or right handed. it can also result from one leg being longer than the other. See a scoliosis X-ray here

5 . Lordosis is an excessive forward curve in the lower spine and is usually associated with a hunchback posture. Common causes are obesity or pregnancy where the weight of the abdomen drags the lower spine forward.

6 .Swayback is the backward curvature of the lower spine

7 . Flatback is where the normal slight curves of the spine are not present and the back is abnormally straight.

8 . Kypholordosis is the combined abnormality of a forward stoop in the upper spine (kyphosis), and a forward curvature of the spine (lordosis), and usually occurs because the stoop puts the weight of the persons head in front of the centre of gravity with a tendency to fall forwards, so the instinctively push their lower spine forward to restore the centre of gravity and maintain a counterbalance upright position. A side view of the body shows a spinal colum with an S-shape.

9 .Kyphoscoliosis the combination of a forward curvature of the upper spine (kyphosis), and a sideways curvature (scoliosis), where multiple abnormalities commonly occur because they may be due to poor nutrition which weakens the bones or muscles, and affects every part of the human skeleton in a variety of ways.

10 . Kyphocostosis is the combination of forward curvature of the upper spine (kyphosis), and deformities of the rib cage (costosis) which involves abnormalities of the chest, such as one that is abnormally flat and shallow, or deep and barrel shaped.

11. Neck stoop can be seen from the side view in a person with a deep chest where the rib cage forms a triangular structure which prevents the spine from collapsing into a C-shape, so it remains straight, but the neck bends sharply forwards.

This information was first posted on 1-1-11 and most of it is derived from my book published between 1994 and 2000

Diagnosis of postural problems ©

The following suggestions give a concise summary of how to diagnose the different types of posture abnormalities.

Most people have mild postural problems but are not aware of them because they generally only see themselves from the front view in the mirror, but, for example, the forward slouch is only obvious when viewed from the side.

1. Forward curvature of the upper spine can be identified by looking at the way a shirt or a coat hangs on the shoulders. If the person is sitting with an upright spine the shirt will hang flat. However if they have a slouch or a stoop the cloth may be wrinkled into folds. The forward curve can then be seen by looking at the person from the side view. Another clue can be seen in their tendency to support their head by having their elbow on a table, and their hand on their chin. They will also look smaller when sitting slumped in a chair, compared to people of the same height who sit upright. If you look at them from the side view the curvature in the upper spine will be obvious.

2. Sideways curvature of the spine can be identified by looking at the person from the front view and noticing that one shoulder is lower than the other. Also the highest shoulder will be parallel to the ground, whereas the lower shoulder will be angled downwards. The persons shirt collar will be lower on one side, and their clothes such as their coat will hang lower on one side. If they take their shirt off you will be able to see that one collar bone is lower than the other, and slopes downwards, and if you feel their Sternum bone from top to bottom well notice that it is tilted sideways. If the person is viewed from behind in the sitting position while they are leaning forward with their elbows on their knees, one side of the shoulder will look normal, but the other side will roll significantly downwards at an angle that can be easily seen to be abnormal.

3. Lordosis is usually easy to identify by the cause. For example, if a woman is pregnant and the womb is large, her belly will be heavy and protruding forward, so the forward curve of the lower spine will exist and can be easily seen from the side view. Similarly an overweight or obese person will probably have a heavy belly which drags the lower spine forward. Also if there is a forward curvature of the lower spine from other causes it will push the abdomen forward to produce a pot bellied appearance.

4. Flatback can be seen from the side where it looks as if the person has a steel rod for a spine, rather than a series of vertebrae that form a slight natural S-shape.

5. Kypholordosis is forward curvature of the upper spine with a corresponding forward curve in the lower spine which often involves chest abnormalities as well, and leaves a crease line across the skin of the abdomen just below the ribs, and the person will appear to have a small pot belly. When viewed from the side the spine has an S-shape.

This information was first posted on 1-1-11 and most of it is derived from my book published between 1994 and 2000

See also posture assessment charts or grids on this video here http://www.youtube.com/watch?v=C_HAgkyVru4&feature=youtube_gdata

Poor posture is unlikely to cause problems such as back pain in the first few years of life, but it can have a more serious effect if it gradually changes the shape of the spine and becomes permanent as the child develops into adult hood. Knowing how to prevent the problem is also useful at any stage in relieving or managing the secondary symptoms.

Poor nutrition affects the strength of the muscles and bones that support the human posture, so good nutrition is important. Similarly any infectious illness that results in nausea, vomiting, diarrhea, poor appetite, and weight loss can weaken muscles and bones so they should be guarded against, and recovery from them should include the appropriate type of exercise to regain strength as soon as possible, especially during childhood.

Other preventive measures include sleeping on bedding that is flat and has the degree of firmness that allows the natural slightly S-shaped curve of the spine to be maintained. e.g. not so hard that the spine is kept too straight, and not so soft that it sags like a hammock. Many bedding companies provide advice on such requirements.

It is important to use appropriate seating for the persons size. The height should be such that the feet can be placed flat on the floor for support. The length of the chair should be in proportion to the length of the thigh so that the lower back is not dragged forward into a curve, and the back rest of the chair should be slightly inclined backwards, and have a slight curve in the mid to lower back area to support that natural slight curve in the lower spine.

When sitting at a desk it should be at a height that the person does not have to lean forward to read, and if the person does lean, they should do so from the hips and not the waist. Writing requires the use of one hand and movements to the left and right side of the page which twists the spine and breastbone, so it is preferable to use computer keyboards which require both hands equally and do not result in twisting the spine. The keyboard and mouse should be level with the forearm when it is parallel to the ground so as not to bend the wrist which can interfere with blood supply to the hand. The computer screen should be at eye height. In general any activity that requires leaning toward a desk should be avoided, but ordinary sitting without leaning forward is not such a problem. If it is the person can use a properly designed recliner chair to rest in and relieve some of the aches that result from postural strains during the day.

For an illustration about computer posture from another website see here

Children who carry heavy school books to and from school in satchels or kit bags may develop sideways curvature of the spine, so they should avoid carrying unnecessarily heavy books, and put them in knapsacks on their backs instead. Similarly, having one leg longer than the other can cause sideways curvature of the spine, but that can be remedied by the use of shoe inserts, and some practitioners specialise in that aspect, and, in some cases orthopedic surgeons can lengthen the short leg. Women should avoid wearing high heel shoes because they lift the heel, and tilt the hip bone, and push the abdomen forward, and curve the upper spine into a stoop. If they still want to wear them they should consider that occasional use in social situations is better than wearing them all the time.

There are numerous other methods, but it is also important to know what normal posture is, and what defects you may have. This can be assessed by looking sideways into a mirror to determine if the spine is abnormally stooped or S-shaped, and by looking front on to see if one shoulder is lower than the other, indicating sideways curvature of the spine.
Throughout history there have been many observations about the harmful effects of poor posture and many methods have been devised to relieve the problems. The most obvious is Yoga, but there are others such as chiropractic and osteopathy, and more recently the Alexander Technique which partly involves raising the head so that the spine straightens out, and then finding a position of balance where the head is directly above the spine and feet so that good posture can be maintained by balance, rather than by straining the muscles to stop the body from falling forward or backwards. Physiotherapists now incorporate some of those methods in their practice, and if deformity is severe it can sometimes be treated by orthopedic surgeons.

Education about the benefits of good posture is perhaps the most important.

Some notes on using braces and straps to correct postural problems

Braces are not a practical treatment for spinal deformities because they can't correct the curve and can weaken the musculature.

Reference: The Specialties in General Practice (1951) p.72-74.

My comment: There are a number of problems associated with wearing spinal straps or braces to straighten the spine. Firstly some people will have other injuries and pains caused by their poor posture, and the brace can make them worse. Secondly wearing them supports the spine, so the spinal muscles don't have to carry the weight of the body and will therefore weaken due to lack of use.

Nevertheless, some people might find them an advantage. Perhaps wearing them occasionally to 'train' the person to adopt a particular posture may be beneficial. For example, in young people with pliable spines, if the brace is worn for a few hours a day, it might gradually straighten the bones, and if they then remove the brace, but maintain that general posture with their musculature for the remainder of the day they may gain some effective improvement in spinal shape without losing muscle tone, and consequently avoid having the problem return. However, it is not something for me to comment on other than that. The Alexander Technique is another way to improve posture, and shoe inserts etc. can correct spinal curvatures which are due to having one leg shorter than the other, or to deal with spinal problems associated with abnormalities of the feet. Other methods such as yoga, osteopathy, and physiotherapy etc. are available.

In general terms - the treatment needs to be tailored to each patient, and what works for one might not be effective in another, and prevention and early treatment are the best options.

The importance of early treatment and correction of postural deformities

"It is important that this treatment should begin as soon as possible; if a curvature is allowed to persist for some time the shape of the bones may alter and there can then be little hope of correcting the deformity." Reference: The Illustrated Family Doctor, 1935, page 620.

People who attribute poor posture to a bad habit, or to psychological factors such as anxiety, or depression, are essentially "blaming the victim" for the failure of treatment. Many treatments may have the best of intentions, and may have some useful benefit, but they can't and won't change the shape of the bones of the spine, which is the real cause of the persistent stoop. It is not ethical for adults to be blaming small children for problems which should have been prevented and treated early. Poor posture is a purely physical problem that needs to be studied and treated as such. Psychological problems may or may not be involved in individual cases but are essentially irrelevant and should be treated as a completely separate issue but only if they exist as an accompanying or purely coincidental aspect.

3.. When you look at the sky with your eyes it looks as though the sun rises in the morning and goes down at night. If you use your brains it doesn't.

The causes of poor posture

While I was looking for the causes of spinal deformities I often found these comments in medical books.

Hunchback is associated with sideways curvature of the spine where it may be due to polio, tuberculosis of the spine, or in old age osteoporosis. However, in three quarters of cases the cause is unknown . Reference The Marshall Cavendish Illustrated Encyclopedia of Family Health (1988).

In 85% of cases of scoliosis (sideways curvature of the spine) the cause is obscure. Of the remainder 10% follow poliomyelitis, 2% due to VonRecklinghausen's disease or neurofibromatosis, and less than 2% are due to congenital bone disorders in the spine, osteochondrodystrophy, Freidreic's ataxia, cerebral palsy, and some muscular dystrophies, Also less than 2% follow empyema, thoracoplasty, or any other factors which change the chest shape during the growth period.

95% of cases are girls, usually starting at the age of 10, although occasionally earlier, and increasing gradually to the age of 15, and the degree of curve does not increase after the age of 15. There is still considerable controversy in the whole field of scoliosis. Reference: The Specialties in General Practice (1951) p.72-74.

Consequently while I was studying the subject I was looking for and identifying the other 85% of cases, the majority of which are generally due to long term biomechanical factors, and can be seen in the list below .

Corset Design Stoop

In previous centuries women have changed the shape of their bodies by wearing corsets.
In fact, the manufacturers of corsets designed them to produce a particular shape to suit the fashion of the time. While they were known to be tight at the waist (e.g. to produce the hour glass shape), they were also designed to alter the shape of the spine in specific ways. Some mothers provided them for their children to wear from an early age, where they were referred to as training corsets - to train the body to gradually take on that permanent shape by adulthood.
Diagram Reference: The Analysis Of Beauty (1739

My review of a book from the 1930's

While I was writing my book called The Posture Theory I found an earlier publication from 1930 which discussed the relationship between poor posture and symptoms in children, and the consequences of not treating the postural defect when the child reaches adulthood. It was called "The Nervous Child", and I reviewed it in the 11th edition of my book on pages 101 and 251, and have given another summary below.

The author of that 1930's book proposed that nervousness weakened the antigravity muscles of the spine which in turn caused poor posture. However he also made the observation that the exercise programmes provided to army recruits improved their posture which in turn improved their health and temperament. (i.e. that improving their posture made them calmer. Therefore it is poor posture which causes nervousness, and not nervousness which causes poor posture M.B.).

This is another quote from that book . . . "The stance of the nervous child may be described as the opposite of that which the drill sergeant inculcates so vigorously in the recruit".
The curative posture in drill results in improved health and temperament"

Curvature of the upper spine often results in a counterbalancing forward arching of the lower spine which is called lordosis which according to the author of that book, pushes the abdomen forward and causes the chest to recede. This physique tends to produce symptoms of restlessness, irritability and fidgeting, digestive disturbances disturbances, and appendicitis. It is also commonly associated with sore throats, and proneness to colds and tonsillitis

There is also an alteration in the circulation of blood which results in paleness of the skin, alterations in skin temperature in relation to exertion, and a tendency to faintness, breathlessness, palpitations, and motion sickness, which are very commonly encountered with children who have this physique.

He adds . . . "If we encounter these children, so nervous, so excitable, so easily exhausted, with their faulty posture and unstable circulatory reactions and describe them solely with the eye of a cardiologist, we shall describe them as suffering from "cardiovascular asthenia" or the "effort syndrome". . . and . . . he observes that such children were likely to become sickly and miserable adults and undergo several forms of surgery unless their postural defect was corrected. He suggested that good exercise and

good diet were important, and that children should be provided with properly designed chairs and desks of appropriate height for their bodies, and that the correction of eyesight problems was important so that children did not need to lean forward to read, in which case the constant bending caused the spine to grow stooped.

Reference: The Nervous Child (1930) p.171-189

The relationship between posture and health has numerous aspects which create confusion about which causes which. However it is most likely that various infectious illnesses, especially prolonged illnesses, which impair appetite or result in a loss of weight or a weakening of bones during the growth periods of childhood, are likely to cause the spine to stoop under the weight of the body, and unless recuperation is rapid, the postural alteration may persist.

Thereafter postural pressure on the chest and abdomen would dispose to numerous health problems. However as long as the child remains active they may be free of most symptoms, but if their lifestyle remains predominantly sedentary, the constant effects of stooped posture may then bring about a variety of ailments in adulthood. M.B.

Popular MYTHS about the cause of poor posture

it is popular to believe that slouching is due to laziness, or because the person doesn't want to sit up straight.

However, the major factor which determines the way a person sits or stands is the shape of their spinal bones. That shape can be determined by an injury which occurs in a few seconds when the person is young, or by poor nutrition or disease which weakens their bones and causes the change in a few weeks or months. Needless to say that if the postural problems are not corrected when the child is young, then the change in shape will become permanent as the bones harden in adulthood. It is impossible to straighten adult bones just by sitting up straight.

Other cause or effect questions

it is also popular to believe that a child develops poor posture as the result of a bad habit, but spinal deformities have physical causes and standing in a particular way is much more likely to be a counterbalancing response than a habit.

The other popular misconception is that sadness causes poor posture, however, it is much more likely that physical factors result in spinal deformity, which in turn causes health problems, which then causes misery as a consequence. Also poor posture can affect the circulation of blood adversely to cause lethargy, and impede blood flow to the brain and have an effect on such things as the ability to concentrate and tiredness etc..

There has also been the suggestion that poor posture is due to stress and muscle tension, but in order to slouch the spinal muscles need to relax and stretch, and, for example, many people slouch in a lounge chair when they are relaxing as they watch sport on television.

It is important to develop effective methods of preventing postural problems, but that is more a matter of education than anything else.

.

A collection of diagrams from the 300 in The Posture Theory

An explanation for the illustrations

When a child is young their bones are soft and pliable. like the trunk of a young tree, especially if they have poor diet, or a long viral illness that affects their appetite, so a variety of factors can change the shape of their spine. For example, sleeping for eight hours every night in a spring mesh bed that sags in the middle, or repeatedly leaning forward to read due to poor eyesight, or being tall and having to bend their neck to talk to smaller children may gradually affect the shape of their spine. As the child grows the bones will curve, and the ligaments and muscles of the back will stretch accordingly, and then the bones will gradually harden by early adulthood. As you can appreciate, it is much more difficult to bend adult bones back to their original shape, and is comparable to trying to straighten a bend in the trunk of a fully grown tree.

However, surgery is sometimes performed in extreme cases of deformity, but the problem can be managed by developing a good understanding of anatomy, and by using methods of sitting and standing which restore effortless balance. The Alexander technique and Yoga provide some insight into those methods. However, as they say, prevention is better than cure.

If poor posture is not prevented or properly managed it can lead to many other health problems where the most commonly known ones are backaches, inefficient breathing, and lethargy - for example they are often referred to as 'slouches' - who haven't got enough energy to do anything.

Some of the effects of poor posture or other types of compression

Culturally induced deformities: The ancient Greeks wore loose garments, and were very healthy compared to other cultures who deformed their bodies by using such things as shoulder binding straps to deliberately produce the hunchback appearance.

Seventeenth century women believed that it was attractive to have a long thin neck and sloping shoulders, so they wore binding straps to achieve that permanent appearance.

The Flat Head Indians of North America strapped boards to the top of the heads of their babies when their skulls were pliable, so that they grew up to be permanently flat in adulthood. They were known to neighbouring tribes to be somewhat dull, probably because the deformity of their skulls affected their brain function.

Education in the history of fashion and health can prevent those problems from occurring to future generations of children.

Row 1 A normal shaped stomach compared to one pushed down by poor posture. Row 2 A normal liver compared with two that have been crushed and deformed by tight corsets Row 3 A normal shaped bowel compared to one pushed down in the middle by poor posture, and an x-ray image of the cramps of the irritable bowel syndrome. The strain on the colon due to the cramps can cause diverticula which are small ruptures in the wall of the bowel that dispose to diverticulitis.

The Posture Theory and Chest Shape ©

If an individual has good nutrition and good health when they are young they are likely to develop a natural spine and chest shape.

The natural shape of the spine, when viewed from the side, is upright with a slight S-shaped curve, and the breast bone is slightly inclined forwards. The breathing muscle or diaphragm forms the base of the chest, and is dome shaped when the person breathes out, and flattened when they breath in.

The overall shape of the chest is therefore triangular, and moves to a somewhat pyramid form if they lean forward or stoop their head, and the overall arrangement is structurally stable.

By contrast, if the individual has illnesses like rickets or prolonged viral infections which weaken their bones and muscles when they are infants, the spine is likely to bend forward under the weight of their head and shoulders, and as the spine forms a C-shaped curve, the lower spine pushes the lower abdomen forward into a pot bellied appearance. That physical shape forms a crease across the front of the upper abdomen and the lower tip of the breast bone tends to be caught in it and pushed backwards each time the child leans forward.

When the breastbone is flattened in that manner, and runs parallel to the spine, it has the shape of a column, more like the leaning tower of Pisa.

The net result is that the child with a triangular shaped chest will tend to push the breastbone forward as they grow, so they will naturally develop a deep chest with a lot of room for their heart and lungs and stomach below, which allows for good digestion, good breathing, and plenty of energy, which, in turn, gives them a competitive advantage in the pursuits of life in sport and business.

However, the child with the stooped spine will have a flat chest, that tends to incline backwards, and doesn't support it, so the spine will become more stooped as they grow. That will tend to limit the room available for the heart, lungs, and stomach, and therefore result in impaired digestion, respiration, and energy levels.

The importance of this concept to parents, educators, health professionals, and public health officials is that the effects of such illnesses on the physique of children needs to be identified as quickly as possible, and then good nutrition, and natural activities and exercises encouraged as soon as possible after recovering, so that permanent and progressive problems can be prevented.

The idea that a combination of posture and chest shape is the cause of multiple symptoms is unique to The Posture Theory.

The Posture Theory began in 1975 as an attempt to explain the co-existence of a wide range of symptoms which were not evident on X-rays or other medical tests and were deemed to have no known or verifiable cause. The generally accepted view was that there were so many symptoms of such a variable nature affecting so many different systems and parts of the body that it was impossible for them to have only one physical cause.

The following four years from 1975 to 1979 involved an assessment of all of the obscurities, contradictions, delayed reactions, variables, and confusing aspects of the problem to produce, in simplified terms, the clear idea that, in some way or other, at some time or other, every symptom was induced or aggravated by a common factor, namely, leaning forward.

The chest pain, breathlessness, and abdominal pain

Essentially, leaning forward compressed the chest to cause chest pain, the stomach to cause stomach pain, the lungs to cause breathing difficulties, and the kidney area to cause aches in that part of the back.

The reason for the cause of the abdominal pain being difficult to determine was because it did not necessarily occur by leaning forward once. It was more likely to occur gradually by leaning forward repeatedly to read and write at a desk for more than an hour, and then gradually get worse throughout the day.

The pain in the kidney area had a similar occurrence where it would gradually start as a mild ache in the left side of the back, and get progressively worse during the day, and sometimes be followed by a similar ache in the right side of the back. It was also aggravated by cold breezes blowing on the back. For example while walking for an hour into the wind there was no ache, but when walking the return journey with the breeze blowing from behind, the kidney area would begin to ache on both sides of the back. That effect could be prevented by wearing an insulated vest.

The cause of the breathlessness was difficult to notice because it sometimes, but not always occurred when leaning forward, and sometimes occurred at other times with other activities such as exercise, and it was also more likely to be a problem in colder months.

Similarly the chest pain would not occur simply by leaning forward once, but was more related to the fact that poor posture put repeated postural on the muscle and tissue between the ribs, and gradually produced a tenderness in the area that could occasionally result in sharp stabbing pains. Also a dull ache might not be present doing normal activities, but occur with each step of the left foot while jogging along the beach, because the foot sinks into the soft sand each time, and the weight of the stooped head and shoulders compresses the ribs together each time, more so on the left side than the right. That is because most people have some degree of sideways curvature in the spine, and one shoulder lower than the other, where that shoulder moves up and down a greater distance with each step.

Other dull or strong pains in the extreme left and right side of the chest are due to muscle cramps that results from the abnormal curvature of the spine, and an abnormal shape of the chest putting more strain on those muscles.

The puzzle of the faintness and fatigue

However, leaning forward also caused a sense of faintness and dizziness, and a sense of fatigue and exhaustion, but the precise mechanism for that was not so clear. For example, how could leaning forward only once produce a sense of faintness and weakness, but other times have no obvious effect, and how could leaning forward repeatedly for only half an hour cause complete exhaustion for two days. How was postural pressure causing that? and what structure in the anatomy was the postural pressure affecting.

Therefore, at that stage, a posture theory was proposed for most of the aches and pains, and another idea had to be developed for the faintness and fatigue symptoms.

During the fifth year of development, 1979, the observation was made that the fatigue was different from normal insofar as it was not only induced by leaning forward, but also, it came on more readily in response to physical effort, and persisted for longer after it had been induced, and was not relieved in the usual way by rest. This was compared to two children on a seesaw, where the heavy child would find it easy and quicker to lower his end of the board, and the light child would find it more difficult and slower, and so the feature of the fatigue in not returning to normal at the usual rate was referred to as a disequilibrium. Hence there was a Posture Theory for all of the aches and pains, and a Disequilibrium Theory for the fatigue.

Valsalva's Maneuver
An attempt was then made to determine how leaning forward could cause fatigue, and that led to a study of Valsalva's Maneuver
which is a scientific method that is used in laboratories for the purpose of inducing stress in humans, and stress is a widely accepted cause of fatigue. In this technique the patient is asked to pinch their nose, and hold their mouth shut, and breath out with force, which increases the air pressure in the chest. That pressure compresses the blood vessels in the chest, and impedes the blood flow from the feet to the brain. The brain responds by sending nerve signals via the nervous system to the blood vessels in the legs, causing them to constrict, and thereby increasing blood pressure to force blood up past the pressured area in the chest and onto the brain to complete the cycle and prevent faintness and collapse.

Leaning forward has the same effect of increasing air pressure inside the chest and reducing the blood flow from the abdomen to the brain.

That fact solved the mystery of the cause of faintness, and dizziness, and nervousness, but more importantly it provided a cause for the fatigue.

In simple terms it means that less blood is reaching the brain, and, as the blood contains oxygen and nutrients, there is less oxygen being supplied to the brain, so there will be more difficulty concentrating and thinking, and more tiredness.

However the mechanism for the persistence of those symptoms at other times needed to be explained, which led to the idea that the constant or repetitive postural pressure was blocking the blood flow through the chest, so that blood would tend to dam up in the veins below, and strain, weaken, stretch, or damage those muscular tubes.

That weakness would explain some other symptoms such as unstable or variable blood pressure. It would also explain why the symptom of faintness would occur when to body was tilted up and down or sideways on a tilt table, but more importantly it provided a cause for the fatigue, because the blood would tend to flow from the left or right side of the body or in whatever direction it was tilted. As the blood was contained within tubular vessels they would stretch as extra blood flowed through them due to the effects of gravity. The increase in the volume of blood within them would then reduce the amount reaching the brain. That would also explain why the faintness occurred when sitting in a swirling show ride at a fairground, or while going up or down in an elevator, or while sitting in a plane which accelerates on take off or decelerates on landing. That led to the question of which part of the veins were affected. It could be the small vessels between the arteries and the veins, or all of the veins, or the major vein in the abdomen which is called the vena cava.

Another clue to the symptoms being caused by weak or stretched veins is in the fact that some people with severe varicose veins in the legs have mild symptoms of faintness when they move from the laying to the standing position. That is because the blood from the upper part of the body rushes down to the feet due to the sudden increase in the effect of gravity, and the varicose veins stretch and hold more blood, so the return of blood back to the heart and brain is delayed for a few seconds. If all of the veins below the chest were affected then the faintness would be worse than if just the leg veins were weak.

Another clue to that possibility is in the previous medical label for that set of symptoms which was 'neurocirculatory asthenia' which means weakness of the nerves and the circulation of blood'.

More importantly it would explain why the faintness and fatigue also occurred in response to strenuos exertion where the increased and more powerful flow of blood would cause those veins to stretch and reduce the blood flow to the heart and brain when it was needed the most. The symptoms would then persist for an abnormal period after exercise because of the time it took for those tubes to regain their previous tone. The elastiscity of those blood vessels would further explain why the symptoms were less likely to be a problem at rest, or while walking, and were more associated with sudden rapid sprinting.

Nowadays that set of symptoms is generally referred to as orthostatic intolerance and exercise intolerance. although it would be more accurate to refer to them as orthostatic inefficiency and exercise limitations.

See also here http://www.internet-marketing-cafe.com/articledetail.php?artid=196822&catid=396

See also this reference on reduced cerebral blood flow in CFS patients here

For my YouTube video on the cause and treatment of faintness see here http://www.youtube.com/watch?v=Xs770_nwq6I

This aspect of The Posture Theory is unique and distinct from other theories for these reasons

1. The cause of the damage to anatomy is repetitive posturally induced Valsalva's maneuver.

2. The chronic fatigue is due to damage to the abdominal and, or peripheral blood vessels.

3. The inefficient blood flow to the brain causes poor concentration and tiredness.

4. The inefficient response of blood vessels causes a reduced capacity for physical exercise.

5.Tilt table tests can be used to detect and measure the instability of blood flow, and hence the severity of the chronic fatigue.

The theories proposed by other authors include the idea that it is due to chronic recurring anxiety, or that it is due to damage or dysfunction of the autonomic nervous system.

The essay called The Matter of Framework

After determining how poor posture could cause fatigue it became possible to write one unifying essay which covered all of the symptoms, including the chest pains, stomach pains, and breathlessness etc. It was a three page article called "The Matter of Framework", which was given that title because it combined a framework of ideas to explain how a framework of symptoms could be caused by the framework of the human body, and it was published in the Australasian Nurses Journal in June1980. That essay has since been referred to as The Posture Theory.

The antique corset book and Visceroptosis

In 1993 an antique shop had an old book from 1895 on display, with the pages opened to show an illustration of the internal organs of a nineteenth century woman who had worn tight waisted whalebone corsets for most of her life. The stomach was pushed from the horizontal position to the vertical position in her belly, and all of the other internal organs were crushed or twisted out of place. The medical term for displaced abdominal organs is visceroptosis. Further reading of nineteenth century literature revealed that such women had horrendous health problems, but mainly horrendous indigestion, and a severe type of bowel disease called muco-membranous colitis, where the inner lining of the bowel would peel off and be passed as strips of skin, and the compression of the womb caused horrendous problems with pregnancy and childbirth. However, the most commonly reported problems were palpitations, breathlessness, faintness and fatigue occurring in response to emotion or exertion. Those problems were the subject of public debates for many years until 1904 when those who described the serious health problems won and managed to convince women to discard their corsets in favor of looser garments. Consequently corsets started to go out of fashion in 1904 and had more or less disappeared from use by the 1920's.

The eleven editions of The Posture Theory book

The Posture Theory book was started in 1994 as a 16 page paper back pamphlet with the aim of adding evidence and improvements to it by using information from all sources, such as research papers in medical journals, natural health magazines, and general and history literature. It was easy to find the evidence which added about 150 pages of information annually until the year 2000 when it became a hardback publication with a table of contents, an index, 130 references, 300 illustrations, and 1000 pages.

Stooped and sideways curvature of the spine
During that time the influence of spinal shape was added to the action of leaning forward, where patients with stooped spines were more likely to develop symptoms because of the additional pressure imposed by that physique, and sideways curvature of the spine explained why some of the symptoms, such as the chest pain, was more common on one side of the chest. The pain may be due to excessive pressure, or excessive stretching of the rib cage on one side. Similarly, a stoop in the upper part of the spine would produce pressure in different regions and from different angles and result in a slightly different set of symptoms than a stoop in the lower half. For example, curvature of the upper spine would be more likely to produce neck ache, chest pains, and breathing difficulties, and curvature of the lower spine would tend to result in more prominent low back pain, kidney aches, and abdominal pains.

The shape of the chest - broad, barrel, flat, or funnel shape
Significant improvements to the theory began in 1993 when the effect of such things as chest shape were considered. For example a large barrel shaped rib cage would protect the chest contents from pressure because as the person leaned forward the breast bone would move over and around the lungs, whereas a small, flat, funnel shaped, and narrow rib cage would dispose to the sword shaped breast bone moving down and backwards and digging it's blunt tip into the junction of the stomach and food pipe. That could cause leakage of the acid from the stomach to the food pipe, which has a weaker lining and be more liable to become painful due to the effects of that acid. Such pressure would also dispose to a faulty function, or spasm of that junction. Similarly all of the lower ribs would put more pressure on the internal anatomy of the abdomen beneath, such as the bends in the left and right side of the colon, and produce additional symptoms.

Leaning from the hips instead of the waist

Ultimately the way a person repeatedly leans forward, in combination with other factors influences symptoms. For example, if a person with a shallow chest leans forward from the waist the spine buckles in the middle and the breastbone recedes backwards to produce a maximum amount of pressure inside the chest, with the likelihood of more numerous and more severe symptoms eventually developing. By contrast, if they lean forward from the hips, the spine remains straight and the breast bone doesn't move backwards, so there is no pressure on internal structures.

Standing to write

Other methods of avoiding the tendency to slouch needed to be developed, and started with the idea of standing and writing on a flat bench at elbow height. The next step was to read and write on at an angled platform so that even less leaning forward is needed to see the text. Finally, learning to type, and then standing in front of a computer with the keyboard at waist height, and the screen at eye height meant that there was no need to lean forwards at all, resulting in a considerable reduction in the number, frequency, and severity of symptoms.

Typing instead of writing - from twisting the spine to a static spine

Another observation was made that writing with a pen requires leaning forward which puts the weight of the upper body on the arm, wrist, and hand, which results in heavy writing that puts deep grooves in the paper, and the mechanical strain disposes to cramps and repetitive strain injury. By contrast standing up straight to write takes that pressure away.

Also, when writing by pen, the hand moves to the left margin of the page and then pushes the pen across to the right side, and then to the left again to start the next line. By the end of the page the pen has moved from left to right and back again about twenty times, which means that the spine, and the breast bone (or sternum) have been twisted to the left and right repeatedly, causing the tip of the sword shaped breast bone to dig into the stomach, and twist left and right as it does so, thereby inducing, or aggravating various symptoms, but particularly abdominal pain.

Typing solved that problem because both hands are used equally, with the left hand staying on the left side of the keyboard, while the right hand is kept on the right side. Consequently the spine and breastbone don't rotate, and hence the symptom of abdominal pain was relieved.

The causes of spinal deformity
Further information was compiled on every aspect of posture and health which included the study of causes. The main one was poor nutrition in childhood, such as vitamin D deficiency which softened the child's bones so that their skeleton collapsed under their own body weight. More obscurely, when infectious illnesses occur in childhood there are often many weeks or months of nausea, vomiting, and poor appetite, accompanied by physical inactivity, and that can result in a loss of muscle tone which can cause gradual and subtle changes in skeletal shape, and if corrective measures are not taken promptly the deformity can persist until adulthood when the bones harden and become set in that position. The enlarging, forward protruding, and increasing weight of the fetus in pregnancy contributes to postural problems in adult women, as do high heel shoes which throw the hips forwards and the upper spine backwards, and the neck and head forwards. The thinning of bones due to the lack of calcium and osteoporosis influences posture in the elderly. The study of clothing shows that the shape of corsets determined the shape of the bones which eventually develop. For example, a low waisted corset will deform the lower spine and hips, whereas constantly wearing a funnel shaped corset in childhood will cause the individual to grow with a permanent funnel shaped rib cage instead of a broad and deep chest. The funnel shape resulted in those women breathing in a shallow manner because their breathing muscle, the diaphragm, could not descend toward the abdomen properly. Hence such women were always breathless, and they relieved their breathlessness and faintness, by unlacing their corsets, but still had minor problems because of the permanent deformity in their bones and bodies.

The history of posture and health

A thorough study of the history of people with straight spines, broad shoulders, and deep chest reveals that they have been renown for their strength, stamina, good health, and success in sport, academic life, and commerce. In fact, for thousands of years Yoga and Buddhism have placed great emphasis on the importance of good posture in achieving a relaxed state of mind, and more recently chiropractic, osteopathy, the Alexander Technique, and physiotherapy have used postural improvement as a means of treating a wide variety of diseases and injury. Moreover methods of improving posture have been taught in private and public schools to enhance the future health and success of the students, and in sporting and military academies to improve stamina, courage, and strength of character, and in singing, acting, radio announcing, and public speaking classes to reduce pressure on the throat and vocal chords to improve the strength, endurance, and quality of the voice, and in music and dancing schools to improve balance, ease of movement, and avoidance of injury, and in modeling and finishing schools for adolescence to improve beauty, social acceptance, and social success.

The first book devoted to the comprehensive study of posture and health

It obviously follows that if good posture has such a powerful influence on a persons health and success in life, that poor posture would have a correspondingly detrimental effect. However the recognition of the harmful effects has been missing, and never documented, studied, or identified in any meaningful, detailed or organized way, and even the recognition of the beneficial effects has waxed and waned from country to country, and decade to decade, from being crucially important, to being a trivial cosmetic aspect of vanity.

One of the main objectives of writing The Posture Theory was to remove any doubt from the matter, and bring the importance of this subject into permanent public consciousness.

Information on prevention, ergonomics, and treatments were other significant aspects of the final Posture Theory which was published in the year 2000 in its 11th edition as a one thousand page book with more than 100 references and three hundred illustrations. It was distributed to public libraries throughout Australia, New Zealand, and North America. M.B.

The Posture Theory web site is an introduction to a 1000 page book which deals with any and every aspect of posture and health, and includes a study of the subject from the medical, research, and popular literature, and brings a lot of scattered, unco-ordinated, and diverse information into one unifying source.

Of course, the relationship between good posture and good health is obvious to observers because the person with a straight spine and broad shoulders looks fit and healthy, whereas the person with a round shouldered slouch looks tired and sickly. Nevertheless it has been the subject of debate for thousands of years.

Another matter that confuses this topic is the observation that some people with stooped spines have good health, but such individuals invariably also have wide or deep chests, particularly with broad shoulders and a forward angled breastbone. That physique provides a large rib cage which would protect the internal structures from the compressing affects of the stooped spine. Hence, the actual relationship between physique and health may be more comprehensively referred to as THE POSTURE AND CHEST SHAPE THEORY which is again obvious from the history of health and general observation, but is better presented as a formal instructional theory rather than leaving it to general unproven assumption. M.B.

An update of The Posture Theory - 2010

The Posture Theory was first published as a three page essay in 1980, and was later expanded to a thousand page book between 1994 and 2000, and continued on this website where I will now give a concise summary in 2010.

Poor posture compresses the chest and abdomen to cause a large range of health problems such as chest pains, breathlessness, and indigestion.

Similar symptoms were seen in nineteenth century women who wore 'hour glass' or 'wasp-waisted' corsets. It was because the abdomen contains the stomach, colon, liver, kidneys and backbone, and major nerves and blood vessels, and, for example, compressing the blood vessels reduces the flow of blood between the feet and the upper part of the body, Faintness and fatigue occurs because less blood is available to the brain. The women relieved their fainting spells by unlacing their corsets and laying down. However, after many years of wearing corsets some women found that they continued to be fatigued even after they unlaced them or stopped wearing them.

The general range of symptoms is also seen in pregnancy as the womb grows larger and heavier and compresses all of the structures around it, and puts pressure on the veins that come up from each leg and join in the abdomen, and the symptoms are generally, but not always relieved after childbirth as the womb returns to it's original size and weight.

Therefore any factor which persistently compresses the chest and abdomen is likely to cause chronic symptoms including fatigue.

Nevertheless some patients report that they were fit and athletic up until they contracted a viral infections such as typhoid, malaria, the flu, or glandular fever etc., and that after recovering from the nausea, vomiting and fever, they remained easily exhausted and could not return to their former sporting activities. Their condition has been called a post-viral fatigue syndrome, and various authors have suggested that the virus may have spread to, or affected the brain. The possibilities are that the brain sends less effective autonomic responses to the blood vessels so the flow of blood is weaker, which was previously called neurocirculatory asthenia, or that the virus has infected the nerves, which was previously called neurasthenia, and there is also the possibility that the virus has weakened the muscle fibres, or other structures in the walls of the blood vessels, although there is no firm scientific evidence for any of those conclusions.

Also, another group of patients will report that they were fit and healthy up until a period of anxiety or stress in their life, and that after the stress had finished they continued to be easily exhausted, and were not able to sustain physical effort as before. Some authors have argued that they continue to be anxious but are not aware of it, and refer to their symptoms as an anxiety disorder, and others suggest that the stress damages the brain, or the nerves or the adrenal glands, and refer to the condition as a psychosomatic disorder.

There are many other possibilities, such as changes in the blood chemistry due to an abnormal pattern of breathing, or changes in the autoimmune system etc, but in general the chronic fatigue is due to any factor which affects the quality or flow of blood to the brain, such as poor posture, tight corsets, pregnancy, and viral or stress damage to the nervous system and blood vessels, and of course, those factors would play a part in the other symptoms and the effect would be more likely if multiple factors were involved. The blood carries oxygen and nutrients so the reduced supply of those essentials contributes to fatigue.

There is also evidence that several slightly different syndromes exist with similar or overlapping causes and symptoms..

Ultimately the methods of preventing, relieving, or treating the symptoms involves improvements in posture, wearing loose clothing, immunising against viral infections, and developing a calm and relaxed attitude to all situations.

It is also not practical to consider these ailments as having one cause, or one method of treatment because it isn't possible to convince a person who has good posture that their symptoms are due to poor posture, or to convince a person who is not anxious that their symptoms are due to anxiety, or that someone who didn't have a viral infection at the start of their symptoms is suffering from a post-viral condition. M.B

A summary of other factors which cause pressure symptoms

i.e. supporting evidence for The posture Theory

from previous essays

Poor posture, due to spinal deformity or slouching, throws the head and shoulders forwards and puts pressure on all of the structures in the chest and abdomen, and sideways curvature of the spine results in greater pressure on those structures on one side. The amount, type, location, and affect of that pressure is also influenced by the shape of the chest, whether it is shallow or deep, and long or narrow.

Pregnancy and pressure symptoms

The effect can be compared to other factors such as pregnancy where the enlarging womb starts to put pressure on the bladder and bowels and cause such problems as frequency of urination. As the womb continues to enlarge it presses on the abdominal structures and then, in late pregnancy, it pushes against the stomach and heart, causing heartburn, palpitations and faintness, as common symptoms.

Reference; Cohen ME, White PD (1951). "Life situations, emotions, and neurocirculatory asthenia (anxiety neurosis, neurasthenia, effort syndrome)". Psychosom Med 13 (6): p.346

Corsets and pressure symptoms

My YouTube video on corsets and related factors can be seen here

Similarly, in previous centuries women wore very tight waisted corsets which caused them a myriad of health problems. Furthermore the low waisted corsets tended to cause ailments related to the bladder, womb, and bowels, such as severe constipation, and some women wore the corsets to induce abortions. The high waisted corsets, by contrast, had a greater effect on the chest, causing chest pains, breathlessness, and faintness. Also the mid waisted corsets pushed the stomach from the horizontal position to the vertical position, and the low waisted corsets pushed the womb from the vertical to horizontal shape, and altered the shape and angle of the pelvic bone and pelvic outlet resulting in such features as shoulder presentation and difficult and painful childbirth

Seven different corset styles
In the seventeenth century corsets were made in various styles, and the shape of corsets worn in childhood detemined the permanent shape of her spine and chest in adulthood.	The Countess of Leicester and her children (1596) depicting the late sixteenth century womens fashion which included corsets worn since childhood to permanently alter the shape of their spine and chest by adulthood. See more information about childrens corsets here	Queen Anne of England (1665-1714) wore corsets. She had chronic ill-health, and became pregnant 18 times but only 5 of her children were born alive.

Collars, Belts and pressure symptoms

Some other forms of clothing produce pressure symptoms, such as high heel shoes, which lift and tilt the pelvic bone, increase the arch in the lower back and neck to cause back and neck aches, and where military uniforms included tight collars, the pressure obstructed blood flow to the brain and soldiers were more prone to faintness in battle, and where tight belts were part of the uniform, large numbers of soldiers developed hemorrhoids.

In general terms any factor which puts pressure on the body causes strain, and impairs blood flow, resulting in local or widespread symptoms and ailments. e.g. when a person crosses their legs the pressure on the blood vessels of the thighs impairs blood flow to and from the feet, and when a tornique or blood pressure cuff is placed on the arm, the increasing air pressure in the cuff puts pressure on the blood vessels, initially restricting blood flow, and if continued, blocks the blood flow completely.

1. In 1975 I wanted to find a way of explaining why a person would feel faint each time they leaned toward a desk, and why the faintness would be relieved each time they leaned back.

2.I began to study the relevant information and soon found that a set of associated symptoms were a part of a condition called Da Costa's syndrome, and later, that such patients were usually sedentary workers with thin physiques with long, narrow, or flat chests, and stooped spines.

3. Some years later I read about a scientific method called Valsalva's Maneuver where a person pinches their nose, and holds their mouth shut, and attempts to forcibly breath out. That process increases the air pressure in their chest and compresses the blood vessels to reduce the blood flow passing through the chest from the feet to the brain.

4. I eventually concluded that leaning forward at a desk was compressing the air in the chest to cause the faintness.

5. However, I needed to explain why such an obvious cause of symptoms was not common knowledge and why people were arguing with me when I explained it. I eventually concluded that most people who leaned forward would not feel faint because their spines were straight and they naturally bent at the hips, and would not compress their chests, but people with stooped spines and flat chests would tend to bend at the waist, and compress their waist and the blood vessels inside as their chest moved forward and down.

6. I also assumed that a sedentary worker who leaned forward ten times a minute to read or write for many years or decades would eventually strain and weaken the blood vessels of the abdomen until the slightest compression of the chest reduced the blood flow to the brain, and that only in extreme cases would a person feel faint every time they leaned forward.

7. Most healthy people would never feel faint when leaning forward, and it would probably be rare for it to be so obviously related to leaning forward in Da Costa's syndrome, but those patients experience faintness, dizziness, and fatigue at other times without knowing why, and although there are many other theories to explain the symptoms, none have been proven.

8. The most popular theory is that the condition is caused by work stress or anxiety, and when the patient says that the work is not stressful and that they have nothing to be anxious about they are told that it is due to "free floating" anxiety, or "sub-conscious" anxiety related to forgotten childhood experiences.

9. Some psychologists also argued that nineteenth century women often felt faint because of psychological factors, and that their typical fainting spells disappeared in the early twentieth century because of advances in psychotherapy, however those women wore tight waisted corsets and they relieved the fainting spells by unlacing their corsets, and corsets went out of fashion in the early twentieth century because of scientific and public debates which concluded that corsets were extremely harmful to health.

10.Similar, but less severe symptoms nowadays relates to the fact that many women still wear girdles, or other garments to narrow their waist, and men wear belts which restrict the downward and forward movement of the abdominal contents and therefore increase the pressure caused by stooping. Other factors have similar effects, and avoiding stooping, and loosening the belt would prevent or relieve symptoms or prevent them from getting progressively worse. M.B.

References: Sir Thomas Lewis (1918) The Soldiers Heart and the Effort Syndrome, Shaw & Sons, London p. 20-29: A large percentage of soldiers who developed the Effort Syndrome had poor physiques and long, narrow or flat chests associated with a kyphotic curve (hunchback spine) and many came from sedentary occupations. "It is unquestionable that many men recruited from sedentary occupations were affected by the condition before joining, although previous to that event in their life-history symptoms had never manifested themselves.The question naturally arises as to the extent to which sedentary work predisposes to the affection; no conclusive answer can be returned from the data at our disposal, though these strongly suggest sedentary work as a predisposing cause". Some of those soldiers experienced giddiness when standing up suddenly, or more rarely, even when laying down, and "a number of tested patients complained of equal giddiness when moved on a swingboard into the lying position" . . . and this . . . "seems to be associated with faulty distribution of the circulating blood during the period of giddiness".

Sir Thomas Lewis (1937) Diseases of the Heart 2nd edition, MacMillan and Co., Limited, London p.97-98 and p.158-164: There is a rare type of postural faintness which is associated with the faulty distribution of blood which tends to accumulated in the abdominal veins. This is closely related to cases where the person feels faint when they stoop down to lace their boots or lift heavy weights, and it occurs because the mechanical or muscular action compresses the abdomen and squeezes the blood out of the abdominal veins. When they stand up again the blood takes a few moments longer to fill the veins, and in the meantime blood flow to the heart and brain is diminished.

See also; Scientific measurements of the pressures in the chest and abdomen which are created by wearing tight belts or corsets or by leaning toward a sewing machine or desk, etc. see "The Corset: QUESTIONS OF PRESSURE AND DISPLACEMENT.* By ROBERT L.DICKINSON, M. D., BROOKLYN, LECTURER ON OBSTETRICS, LONG ISLAND COLLEGE HOSPITAL here

Also called the Effort Syndrome, and nowadays a main type of Chronic fatigue syndrome

Pictured right: A Life-sized portrait painted by Ian Tillard features the typical face, build, and posture of a patient with Da Costa's Syndrome. It was displayed in the Museum of the Post-Graduate Medical School of London. Reference: P.Wood, O.B.E. (1956) Diseases of the Heart and Circulation, 2nd edition, p. 941.

(As far as I am aware it was considered so important that it was on display for several decades - some of the observers of that painting must have noticed the possibility that the physique was a significant determining factor in causing the typical symptoms, but no-one took it any further, or had any influence on the literature of the topic).

The stooped spine, thin physique, and sloping shoulders, are evident by the crinkling of the coat which can be seen in the painting and has been used as a visual guide to the diagnosis of kyphosis which otherwise goes unnoticed.

Individuals with such a physique typically lean on tables and support the weight of their head and shoulders with their elbows, and their breathing generally requires more effort because each time they breath in, the head and shoulders are pushed upwards, and when they breath out, the head and shoulders fall.

Hence there is constant strain on the diaphram muscle acting sixteen times every minute of the waking day, which is made worse in the seated position, and particularly when the upward movement of the diaphram is opposed by leaning forward.

Children who develop such posture due to poor nutrition or illness when they were young typically grow up to be sickly and miserable adults because of all of their health problems, which is reflected in the mans face above. M.B.

Tight Belts

In the nineteenth century it was common practice for some of the soldiers of most armies to create a broad shouldered appearance by tightening their belts to narrow their waist, which would have restricted their capacity for deep breathing, which is required during exertion, such as marching at double quick pace with a heavy, fully laden knapsack strapped to their shoulders. M.B.

See also here

A typical Da Costa's patient

Including the past and present physique, health, and personal history

He was generally aged 30, and previously did clerical work but was currently unemployed, He had a thin build and long chest, was never robust, got frequent sore throats and colds as a child, had his tonsils and appendix out, and was "unable to sit and lie quietly". He also had a weak stomach, and had his kidneys damaged by Scarlet fever, and there were frequent fluctuations in the color and volume of his urine. "He has always been nervous and easily fatigued", and he "was never allowed" to take part in competitive sports and has felt inferior physically to others of his own age. He 'never got over' his attack of grippe three years ago, and since then has had gradually increasing pain in his heart, shortness of breath, dizziness, faintness and weakness. All of his symptoms are made worse by exertion or nervous strain". . .the breathlessness "is not true air hunger, but literally a 'shortness of breath,' a feeling that deep breath cannot be achieved. The patient usually localizes this sensation in the chest wall itself" . . . "which seems unable to expand normally", and this produces frequent sighing, which "is not commonly present in patients with organic heart disease", and is important in making that distinction in diagnosis . . . and "many theories" have been used in the past to explain the cause of the syndrome, and have since been disproven or applied ot "a selected group of cases". There had been widely varying opinions which may each have a "fragment of truth". The 1939 author mentioned ten which included "Pressure from clothing".

Reference: Caugney J.L. Jnr., M.D. (April 1939), Cardiovascular Neurosis; A review. Psychosomatic Medicine,Vol.1 No.3, April 1939

Another reference which describes the typical physique

The constitutional type occurred in children, youth, and early adult life, and most soldier's who developed it already has the minor syjmjptoms prior to enlistment . This type were generally tall and thin, with long narrow chests which are 'rounded in cross-section', and forward curvature of the lower spine which pushed the abdomen forward into a 'bottle-shaped' appearance, and included visceroptosis with the heart, stomach, and liver etc positioned lower in the torso.

"The next commonest type is of course build. The chest is broad but flat."

Symptoms: The pulse rate changes when they move from the upright to the reclining position, or in response to fear or other emotional stimulus, and they get palpitations with violent effort "such as the usual exercise test of hopping or forward bending" with the pulse rate taking up to several hours to return to normal. There is soreness in the skin on the left side of the chest in one quarter of cases, and in others there is general sensitivity in parts of the chest, but mainly in one rib space. Giddiness occurs mainly when getting out of bed, or with physical or emotional effort, and tends to become less noticed later in the day. Faintness or sometimes actual fainting occurs with patients reporting from 1 to 100 times, and is brought on by "the cessation of sudden effort, severe coughing attacks, deep breathing, the effort to stool, the sight of blood, a typhoid inoculation,, or a small pox vaccination". In most cases the patient feels the faint coming on and sits down to avoid falling and injuring themselves. During the faint the pulse may become imperceptible but gradually return to normal after a few seconds or up to five minutes. Dermatographia is the ability to write on the skin where running a fingernail lightly down the skin leaves a red or white line, and according "dermtographia is practically universal".

Medical tests: "Orthodiography, x-ray, and fluroscopy" have shown "small" hearts which overact and "swings widely" "like a see-saw". Blood pressure observations correspond to the extreme lability of the entire vascular apparatus", but cardiograms are normal and there was no evidence of disease of the heart, and it is important to interpret those factors properly so that the patient does not develop cardiophobia (fear of heart disease), as that will not be helpful in treating the problem. The post viral types generally recover, but the 'constitutional' types involve "periods of practical recovery and remission".
Reference: Rothschild Marcus A. (April 1930) Neurocirculatory Asthenia, The New York Academy of Medicine, Vol.VI, No.4, p.223-242.(Annual Graduate Fortnight, Functional and Nervous Problems in Medicine and Surgery, October 7 to 19, 1929)