Upright and uptight: the invention of posture
When did we start telling each other to stand up straight? How did posture become so loaded with meaning? And what can the history of this strange idea tell us about how we approach health and pain today?
Part 1: from military to civilian life, and into medicine
According to historian Sander Gillman, the injunction to stand up straight has its roots in the development of the military drill formation in the sixteenth century. Postures like the one shown in this Flemish engraving started as practical instructions on how to best handle weapons like muskets and pikes. But Gillman says that by the end of the eighteenth century they had taken on a broader meaning as the way to mould a man into a soldier. Posture became a way to transform a person into someone different, and a way to enforce discipline.
These ideas moved into civilian life throughout the eighteenth century. Neopolitan actor Tiberio Fiorillo found fame in London as a “posture master”, teaching comportment to the wealthy and fashionable. Samuel Johnson described the posture master as “one who teaches or practices artificial contortions of the body”, suggesting that to Johnson at least, ‘good posture’ wasn’t a natural state but an imposed one.
As posture became more of a feature in civilian life, notions of good and bad postures took on greater meaning. In the nineteenth century, posture became closely associated with notions of health and illness, with trends like Swedish gymnastics and German krankengymnastics, antecedents of modern physiotherapy, introducing the idea of ideal posture and pathological postures — like the familiar kyphotic, lordotic, flat back and sway back. The middle classes in particular spent their money on self-care books, which sold in their millions, teaching them how to stand up straight. And with notions of illness go notions of morality: Gillman writes that by the middle of the nineteenth century, “the line between [posture] and moral position had become completely blurred”.
In 1855, German anatomist Christian Wilhelm Braune brought the study of posture to medicine by dropping a plumb line down the backs of his research subjects as they stood to attention, and measuring the various results. According to historian William McNeill, this quantification of posture became the basis for the discussions of the “straight line inside the body” that inform modern orthopaedics.
By the end of the 1800s, posture, having broken out of the military into civilian life, had become infused with meaning about not only discipline, but also health and illness, and morality and decay. It had also become medicalized. Then came a remarkable few decades of what historians David Yosifon and Peter N. Stearns call the posture wars.
The people of the nineteenth century had been aided in their efforts to sit and stand up straight by their stiff, more formal clothes — such as corsets, jackets and greatcoats — and by their upright, less accommodating furniture. But towards the end of the nineteenth century, clothing and furniture became less restrictive. This reflected a wider ideological shift in society away from propriety and towards being more relaxed and comfortable. It was closely linked with the rise of consumerism: relaxed, pleasure-seeking people buy more stuff. And so corsets gave way to the deliberately loose, unconstraining dress of the flappers, for example; and hard backed chairs in the living room were replaced by springy sofas. As a result, people started slouching and slumping.
But no cultural change goes unchallenged. Many people fought hard to protect traditional habits and practices from the rise of consumerism and relaxation of discipline. Posture became a kind of battleground for a cultural counter-attack that would last well into the 1950s: the posture wars.
This counter-attack consisted of endless medical and moral arguments for good posture, particularly targeting children and their anxious parents. Posture became a focus of parenting manuals, and in 1890 half of children were identified as having ‘abnormal’ spinal curvatures. By 1920, the school had become the primary site for posture correction. Jessie Bancroft, one of the founders of the American Posture League, encouraged teachers and school nurses in her book The Posture of School Children to develop their acuity in spotting children with poor posture. Yosifon and Stearns describe the postural correction programmes run in American public schools as a “crusade”. American colleges began to assess, photograph and correct students’ postures on enrollment, leading to scandal decades later when photographs of naked students were discovered in the archives of Ivy League schools. The use of schools as a battleground for the posture wars was, according to Yosifon and Stearns, motivated by a desire to reinforce discipline on young people.
In these more relaxed times, etiquette was no longer a credible argument for keeping good posture, and so medical justifications were used instead. Posture was seen as an important part of good health, and the body conceived of as a machine that should be kept in alignment. Slouching and slumping was said to constrain the organs from performing their proper function. This medicalisation involved the codifying and quantifying of posture in, for example, the Bancroft test (1938) or Iowa posture test (1940). Exercises became the main method of correction, and in America Bancroft drew on the German, Swedish and military exercise systems that had emphasised posture during the nineteenth century.
The association of posture and morality continued, and perhaps increased; one doctor reported was that bad posture was a giveaway for “sneaky people, cowards and criminals”. One way people reasoned this out was by linking poor posture to a weakness of character and a lack of self-control. We see the same logic today in discussions of obesity.
Yosifon and Stearn say a key driver of this medicalisation was simply professional interest. Medicine and medicine-adjacent disciplines began to incorporate posture as a way of increasing the social importance of their own disciplines. For example, in 1927, Chiropractors began to run Miss Perfect Spine contests, mixing ideas of health and beauty to promote their new discipline. An early physiotherapy textbook, Lectures on massage and electricity in the treatment of disease, advocated parents check for spinal curvatures yearly because “it is impossible to exaggerate the importance of detecting the malady early”, and provided instructions on best sitting posture to maintain a healthy spine. The writer, a physician, explains:
To modern eyes, the most unpleasant strain of this history was the association of posture with national or racial superiority. Increasing immigration was one aspect of the rapid societal change in this period, and anxiety about this seems to inflect posture discourse. The American eugenicist B G Jeffries said that “perfect posture is the antithesis of illness and moral decay”. Psychologist William Sheldon used the Ivy League nude photos to develop his theories of ecto-, endo- and mesomorphic body types, and their relation to social hierarchies. In 1922 Lancet noted that “some primitive races who have the squatting habit […] keep the knees and back bent and have a carriage and gait not much better than that of the higher apes. As a general rule, the more highly civilised the people the better is the carriage”. European racial science employed the concept of the plumb line to demonstrate that Eastern races were weaker and more corrupt. These ideas found their extremes in Europe, Russia and China, where fascist, Stalinist and Maoist societies explicitly associated posture with their various political projects. Marxism saw the upright posture as “the moral orthopaedics of human dignity” (Ernst Bloch); fascism saw it as a defining trait of the Aryan ubermensch.
In the end, liberal consumerism and the ‘relaxed mode’ prevailed. Slouching, once novel and rebellious, has become so ordinary that during his tenure the most powerful man in the world, Barack Obama, routinely sat in the Oval Office with his feet up on his desk.
Yosifon and Stearn claim the posture wars were won abruptly in the sixties, with the “virtual disappearance” of posture talk from moral, medical and childrearing discourse. For example, in 1967 physician J P Keeve wrote a “myth busting” anti-posture article in the Journal of School Health, sounding remarkably like a retro Adam Meakins. It’s interesting to see that ideas that seem edgy and counter-intuitive now have actually been around for half a century.
But we know that posture didn’t go away. Most physiotherapy textbooks continue to devote a few columns to it, and most physios still assess it, although in more (spuriously?) sophisticated terms, such as scapula positioning, pelvic tilt and segmental stiffness. As recently as a decade ago a series of physiotherapy trials tested postural training and education in schools with children as young as nine, admonishing them not to be like the cartoon character “Lazy Leo, who makes his discs very unhappy by being lazy and doing everything wrong”. The researchers put posters in classrooms, trained teachers to spot and correct poor posture, and recruited a cadre of children to snitch on others, just as the American Postural League did one hundred years ago. It seems that posture is still, at times, a covert means of controlling and disciplining children, and that physiotherapy can be complicit.
The wider culture, too, still expresses anxieties about social change through posture, for example in fears of new technologies causing “text neck”, or longer working hours necessitating standing desks. Devices like Upright™ attach to the wearer’s lumbar spine and vibrate when their back starts to curve. Our culture is still contaminated by some paranoid or punitive ways of thinking about posture.
What are today’s posture wars? Lessons for physiotherapy.
We have seen how health professionals drew on ideology from the wider culture about discipline, health and anxiety about change, repackaged it as scientific, and incorporated it into practice. Our preoccupation with posture might be waning, but what has taken its place? I want to give three ideas, and we needn’t look far to find the first. Remember that physios who kick against the idea of posture did not break free from ideology, they just went with the tide of history. So, ‘progressive’ ideas about posture are just as influenced by culture. Here is an infographic by Adam Meakins:
You can see the triumph of the “relaxed mode” here, and the triumph of liberal consumerism in the way he champions the individual: we are all normal, there is no one right way to be; you are your own unique person. If we look for this individualism, we can see it the way we approach other things too. We want our patients to be able to ‘independently self manage’ and fear that manual therapy and other passive treatments will cause patients to become ‘dependent’. We tend not to consider that interdependence, or even positive dependence — what David Nicholls calls connectivity — are potentially more social, holistic aims.
Secondly, let’s look at another graphic, this one produced by the Chartered Society of Physiotherapy in partnership with health insurance company Aviva to “help keep staff safe, healthy and productive at work”.
The CSP says it welcomes Aviva’s recognition that physiotherapy is “key in reducing or even preventing the time people need to be absent from work”. This recalls the association of good posture, beginning in the 1920s, with Fordist efficiency — the body as a productive machine. Social scientist David Harvey says that in modern societies, the value of a person is defined by their ability to be productive economically; by extension, sickness becomes ‘the inability to work’ and health is ‘the ability to work’. This particular CSP campaign attempts to maximise the individual’s status as a productive employee, rather than change the working conditions that prevent employees, and patients in general, from living healthy and fulfilling lifestyles in the first place.
Finally, let’s consider how posture discourse used the metaphor of the body as a structure with its own alignment, the plumb line — later developed into the body as a machine.
Physios are doing everything we can now to rid ourselves of this metaphor, and pain science is rushing in to fill the vacuum. But pain science relies on its own reductive metaphor: according to historian David Morris, it is the idea that pain is electrical impulses running through our circuitry. Physiotherapists use this metaphor in practice: for example, both proponents and opponents of manual therapy now speak in terms of cascades of ascending and descending impulses. And ‘therapeutic pain neuroscience education’, developed by clinicians such as Dave Butler, Lorimer Moseley and Adriaan Louw, uses neuroscience metaphors to ‘explain pain’ to patients.
But physician and poet Shane Nielson says the circuitry metaphor omits the meaning of pain. Admittedly, pain neuroscience education, especially Explain Pain, accounts for individual factors, but it does this by incorporating them into the clinician’s metaphor. This belief makes your cortisol do this; that behaviour makes your PAG/RVM do that. But what would pain education look like without using a single circuitry metaphor? Is it possible to meet those in pain “at” their meaning — be it religious, superstitious, emotional — and work there, with them? Or must we always set the terms: lordosis, sway back, flat back; alarm signals, synapses, pain orchestra?
The past can illuminate the present. It shows us that the things we value, the assumptions we make, and the metaphors we speak in are human-made and of their time. I’m not trying to suggest that the things I discussed here — posture variation, workplace health and pain science — are unscientific or illegitimate. In fact, I deliberately chose things I believe in and advocate myself, so as not to pick easy targets. I think it is the things we take most for granted that deserve most scrutiny. Hopefully, more physios consider the history of our discipline — not just to congratulate ourselves on how far we have come, but to critique current practice and reach a deeper understanding of why we do what we do.