Intended for healthcare professionals

Rapid response to:

Clinical Review

Assessment and management of medically unexplained symptoms

BMJ 2008; 336 doi: (Published 15 May 2008) Cite this as: BMJ 2008;336:1124

Rapid Response:

The cause of poor posture is generally attributed to laziness, lack of self respect, or misery, and I suppose I may have also held that opinion if it was not for the fact that I had a very poor posture myself ever since I was very young, when I was confident, and was not lazy or miserable.

Many years later, at the age of 25, I began studying the subject and writing about it in various publications where I determined that measles at the age five, and hepatitis at age six, and carrying a heavy kit bag to and from school each day contributed to the weakness and stretching of my spinal ligaments and bones to produce kyphosis and scoliosis.

I then tried to find evidence to confirm those conclusions and was eventually able to do so by comparing examples from history.

I have recently discussed some of my findings in BMJ on 30-4-14, and would now like to present the additional evidence.

Alexander Pope once wrote . . . “Just as the twig is bent the trees inclined”, which is a general observation based on the fact that a small tree has a pliable trunk, and as it reaches maturity the trunk will harden and remain in a fixed position.

Consequently if it is allowed to grow straight it will do so, but if it is roped and staked into a curved position it will grow in a curve, and remain in that shape even when the rope is removed.

A good example of natural events causing the curvature is a tourist attraction in Holdfast Bay, South Australia, called The Old Gum Tree, which is curved into an arch from ground to ground.

In 1993 I found an illustration of the internal anatomy of a nineteenth century woman who had worn a narrow waisted corset, and her rib cage had been changed from broad based to v-shaped.

I then found the concept of the “training corset”, where mothers placed their children, as young as four years old, into corsets for most hours of the day and night, and kept them clothed in corsets as they grew, for the deliberate purpose of developing that permanent body shape in adulthood.

I then found an illustration of several different corset shapes from the eighteenth century drawn for comparison.

Some were designed to produce a backward angle in the spine, others to produce an abnormal arch in the lower spine, and a third type combined it with an abnormal forward curve in the upper spine.

Other sources presented designs which pushed the breasts forwards, or the buttocks backwards.

I then found illustrations of seventeenth corsets which produced the V-shaped torso to create the broad shouldered and narrow lower waisted appearance.

I also found that some women strapped their shoulders to produce the round shouldered appearance which was considered to be attractive, and some tribesmen strapped their shoulders to deliberately create the hunchback appearance.

I also found examples where people used similar methods to permanently alter the shape of other parts of their bodies, such as the flat head indians who placed their babies in a type of basket which they carried on their backs during the day.

The top of the basket included a flat board which was roped over the babies head, to train it to become permanently flat.

Other people altered their head shape to become round, oval, pointed, or square.

There were also examples of tribesmen who pierced their ears and hung weights from them, and gradually increased the weight until the ear lobes reached their shoulders.

I also found that some authors referred to Alexander Pope as the hunchback poet so I read a biography about him which reported that at the age of three he was knocked over and trampled by a wild cow which also injured his throat with it’s horns, so there are two possible causes emanating from that injury.

The first is that the cow broke some of his spinal bones and they healed bent, and the second is that the cow had bovine tuberculosis which can be transferred to humans by blood contact, where it then typically travels through the blood stream to infect the spinal bones which collapse into a permanent bend.

When the upper spine curves forwards the body would tend to fall forwards, except for the fact that reflexes counteract that tendency by producing a corresponding arch in the lower back, and Alexander Pope was described as having both structural changes.

There are other examples where the enlarging womb of pregnancy places weight forward and drags the lower spine forward, and can cause changes in the shape of the spine, as can long term obesity where the abdomen is large and heavy.

Some people who are involved in occupations where they maintain the same posture all the time may develop changes for that reason.

I also found that Vitamin D deficiency can weaken the bones and cause postural changes in children, and Osteoporosis can cause such changes in the elderly.

In summary the main causes of poor posture are changes in the shape of the spine due to poor nutrition, infections, and long term or repetitive mechanical or biomechanical factors, and in most cases it can be prevented and treated by good education about the process.

References . . .

1. 1650, John Bulwer, Anthropometamorphosis, London, U.K. (European corsets and native tribal fashions).

2. 1753, William Hogarth, The Analysis of Beauty (for the 7 part corset diagram).

3. 1874, Luke Limner, Madre Natura Versus the Moloch of Fashion, Chatto and Windus, Piccadilly, London, U.K. (corsets).

4. 1930, Edith Sitwell, Alexander Pope, re-published in 1948 by Penguin Books, Hammondsworth, Middlesex, London, p.28.

5. 1974, D. Holloway, Lewis and Clark and the Crossing of North America, Wiedenfield & Nicolson, London. (The flat head indians).

6. 2014 (March 30th), M.A. Banfield, The Posture Theory as an explanation for many previously unexplainable symptoms, The British Medical Journal (Online Rapid Responses), BMJ 2008;336:1124

7. Banfield M.A. 2014 (April 20th), The cause of poor posture and previously unexplainable symptoms, The British Medical Journal (Online Rapid Responses), BMJ 2008; 336 doi: (Published 15 May 2008), BMJ 2008;336:1124, Actual page of response is

Competing interests: No competing interests

10 August 2014
Max Allan Banfield
Unit 6, No.6 Hartman Ave., Modbury, South Australia 5092