Edward Reynolds and Robert W. Lovett

“ The best results in back-strain are to be obtained, not by attempting to strengthen irritated muscles at the outset by further use, but by temporarily putting them at rest by relieving the strain of the posterior musculature.
A properly fitting corset with a tight pelvic hold not only improves balance, but incidentally serves as a splint and support. The blacksmith who is to do heavy work with his arm puts a leather strap around his wrist to enable his muscles to work to better advantage. ”

“ We use the term "bad corset" to designate that whole class of corsets the use of which we have learned to asso­ciate clinically, and to some extent experimentally, with the existence and production of static backache. All corsets of this class have definite common characteristics. All produce the same effect on posture when submitted to exact observation, varying only in the degree of their results. All tend to increase or produce static backache if persistently worn. ”

“ The orthopedic surgeon will be wise to refer to the gynecologist for a preliminary examination and opinion by which to guide treatment, those cases in which the history, or the replies to the usual questions, are suggestive of uterine disease. This is especially important when the symptoms suggest the possible presence of inflammatory disease of the intrapelvic organs, since in these cases, as has been said above, alteration of attitude, such as would be indicated by the back-strain alone, may be distinctly harmful. ”

“ It must be admitted that, irrational as it is, many cases of backache are relieved by the use of corsets and high-heeled shoes alone. In a larger number this is a most useful preliminary to further attempts at radical cure, and we must remember that we shall be really curing such patients only when we have found and removed the condition which caused the disturbance of balance inducing the back-strain. ”

“ If the patient is a woman and any abnormality of her uterine system can be found, it is usually considered adequate reason for immediate treatment by the gynecologist. If some innocuous uterine peculiarity is oper­ated on in order to cure a backache which is dependent on an overstrain of the back muscles, the results are not likely to be gratifying to the patient or to add much to the reputation of the surgeon who performs the opera­tion. ”

“ It is generally conceded that during the presence of an acute symptomatology the inflammatory affections of the pelvic organs should have depletive and soothing rather than radical treatment. In the more acute cases the muscles of the back are almost invariably in a state of irritation and spasm, and no part of the initial palliatory treatment is more impor­tant or more promptly grateful to the patient than rest in bed, support to the irritated muscles, hot packs, the local electric light bath, etc., for their relief. ”

“ To begin by gymnastics on muscular development under these conditions is to exercise still further for perhaps half an hour daily, muscles already overused, and for the remaining fourteen hours of the twenty-four the irritation induced by the malposition goes on, for a correct position cannot at once be substituted for an incorrect position. It is a frequent experience to find the backache made immediately worse by such treatment, even when given by skilled persons. ”

“ The base of support of the upright human figure consists of a trapezoid formed by the outer borders of the feet and lines connecting the back of the heels and the front of the toes. The center of support lies perpendicularly under the center of gravity and must always lie within this trapezoid. ”

“ After a long series of experiments it became evident that high-heeled shoe, tip the body back as a whole without making any appreciable change in the lumbar curve. Figure 9 is an instance of these records. There was but one exception to this effect in our observations on high­-heeled shoes. This was in a rather degenerate type of girl whose center of gravity was naturally abnormally far back, and it is probable that her inability to tip further back without falling, forced her to compensate by forward muscular effort against the shoes. ”

“ For these reasons it was necessary in our corset work to take a fresh observation of the normal attitude before each corset observation, to insist that each corset observa­tion should be followed by at least fifteen minutes' com­plete muscular relaxation in a recumbent posture, and to limit the number of corset observations in any one sit­ting to two at most.
In their effects on the antero-posterior position of the body, corsets may he divided into three classes and each class must be studied separately if clear results are to be obtained. ”

“ We selected female rather than male models because they were more easily obtained and more reliable, also because the condition under study occurs much more frequently in women.
Professional models, although clearly the only available material for our purpose, present certain disadvantages which we recognized. They are necessarily of stable types of figures, as otherwise the long-continued assumption of one position necessitated by their occupation would be intolerable, whereas we should have pre­ferred to study women of the unstable types of figure. ”

“ The pressure of the hand in the small of the back while sitting, or the use of a cushion in the same region in sitting or lying, are instinctive means of relief which every practitioner has seen these patients use. ”

“ It is only necessary to allude to the fact that the general condition of the patient must, of course, he attended to from the outset. After a week or two of such treatment, aimed at resting tired and irritated muscles, the patient is generally ready for the second stage of the treatment, muscular development as a means to the attainment of a permanently correct attitude. In irritable cases the exercises should be given at first in the recumbent position and later only in the erect position. The whole tendency of most medical gymnasts is to overdo both the massage and exercise at first. ”

“ The patient should then pass the hand inside it and lift the abdomen into it, settling the front of the corset as low as possible. The lumbar lacing should be pulled comfortably snug. The sacral lacing should then be made as tight as can be borne, and if the corset is so made as to spare the iliac crests, and properly cut out for the thighs in front, very tight lacing around the solid pelvis is comfortable to the patient. The dorsal lacing should be left as loose as is comfortable. ”

“ One is dealing in most instances not with athletes with well-developed muscles, but with men, or more often women of less than average physique as a whole, whose back muscles in particular are overstrained, weak and irritated. ”

“ They are all in greater or less degree beneficial to those who suffer from static backache.
The common characteristics of all the forms which we class as good corsets are (1) that they are short behind (especially at the top) and relatively long in front (especially at the bottom) ; (2) they fit the wearer tightly around the pelvis (especially in the space between the iliac crests and the trochanters) and decrease regu­larly in pressure to their upper edge where they are very loose (especially behind) ; (3) they are considerably incurred at the waist line at the back and sides. ”

“ So, too, the orthopedic surgeon who devotes months of effort with apparatus and gymnastics to the relief of back strain caused by the faulty posture origin­ated by inflamed pelvic organs is likely also to fail.
Outside of the gynecologic treatment, patients of either sex are treated by jackets, corsets, plaster strap­ping, splints, pads, springs, belts, massage, vibration, gymnastics, heat, electricity, etc. ”

“ It also frequently shoots down one or both legs, in which case it is gen­erally classed as "sciatica" and is aggravated by forward bending or flexion of the thigh with the knee extended. The pain in the back and leg are aggravated by stand­ing, and especially by prolonged standing, such as is involved in the fitting of women's dresses. It is sometimes relieved by the recumbent position, but at times is at its worst when the patient rises in the morning. ”

“ If the back is exposed and the finger-tips are placed over the erector spinæ muscles, perceptible spasm may be excited in these muscles by voluntary forward or lateral bending at the waist, and perfectly normal spinal mobility is unusual in the more marked cases. Bending is frequently better performed to one side than to the other. ”

“ The attitude of round shoulders is a vicious position of the entire body and not of the shoulders alone, and its treatment by gymnastics would be made more exact and efficient if the attitude were analyzed. (d) Some incidental experiments showed that the effect of corrective gymnastics must be studied by some more exact apparatus than the eye if they are to be correctly and efficiently prescribed. (e) The static conditions evidently underlying the ptoses of the various abdominal viscera form a most promising field of study. ”

“ They tend to correct vicious balance by carrying the center of gravity backward, thus relieving muscular strain. They partially splint the lower back. They furnish an artificial annular ligament to the glutei muscles. High-heeled shoes are also to be recommended temporarily, when comfortable to the patient, because experimental observation has shown that they carry back the center of gravity, and clinical experience is generally confirmatory of their good effect. ”

“ A series of horizontal metal arms, tipped with celluloid, slide easily through holes in the vertical wooden arm. These metal arms are shaken out to their full length, and their ends pushed rapidly and lightly against the subject's back in the median line, the point of the uppermost horizontal arm being applied to the seventh cervical vertebra. ”