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Medical and Orthopedic
Gymnastics ^


Lecturer in Medical Gymnastics and Orthopedy in the Royal

Carole an Medico-Surgical Institute and Director

of the Gymnastic Orthopedic Institute,


With a Frontispiece, and
94 illustrations in the text

Fifth Revised Edition in English


New York and London






The 1st Swedish edition was published in i8g6

Two German editions were issued in iSgy

A French edition appeared in j8g8

The 1st English edition was published in l8<^g

The 2d Swedish edition was published in igo2

The 2d English edition was published in igo2

The right of translation into Italian and Russian

has been transferred


Thw book has been adopted as a text-book at most of the Colleges for Physical Training
and Medical Gymnastics in England and America.


// is the author s pleasant task gratefully to acknowledge
that the first Swedish edition {l8g6) of his " Handbook of Medi-
cal Gymnastics " has met with greater success and attained a
wider circidatio7i than he had dai^ed to anticipate.

That a large edition of a work treating such a special sub-
ject should be exhausted in Siveden within so short a period as
only six years, shows, however, that not 07tly gymnasts, but medi-
cal men also have studied the book. The second Sivcdish edi-
tion has had a rapid sale i?t Sweden, and, moreover, has obtained
a someivhat extensive circulation ifi Norway, Denmark, aitd

A 7tew edition of the handbook has also been issued in
German a?id FrencJi.

The first Eiiglish edition 7uas published in Londo7i, l8()(),
the second in New York and London, ig02, and a third is now
required in New York and Lojidon, which demonstrates the pleas-
ing fact that Medical Gymnastics according to P. H. Lings
system has obtained acknowledgment and increasing adoption in
England and America. The present new edition Jias undergone
a thorough revision. There are included, in addition, references
to the descriptions of correspcitding movements in Zander s trea-
tise on '^medico-mechanical,'' or Zander s. Gymnastics. In con-
nection therewith ought also to be mentioned that in several cases
the correspondence between the movements is only approximate.
Especially are the starting positions for the gymnastic move-
ments, taken in a proper sense, very often different. Concerning
the '' gymnastic manipulations,'' as is natural to suppose, the Zan-
der apparatus cannot take the place of manual massage, but




may exercise *tlie hand'gfips of sue J i kind as enter into a general
medical gymnastic prescription. For valuable Julp in arranging
the above-mentioned equivalents in the denominations of both
systems of gymnastics I have to thank Dr. Emil Zander. I
sincerely hope that the third edition of my Jiandbook ivill meet
with the same kind reception in England and America as the
first one did, both amongst gymnasts and members of the medical

Stockholm, October, 1^0$.



There is scarcely any cleai'er evidence that the inheritance
left to his countrymen by the talcftted Peter Henry Ling in his
systematized and scientifically based method of Gymnastics has
been well maintained and improved by them tJian the fact, that
the whole civilized world is now acquainted with that method,
and honours not only the master but also the laiid to which Jie
belonged by its general adoption of the term, " Swedish Gymnas-
tics. " Even previously to Ling's death in l8jg, tivo State
institutions ivere founded in Stockholm — tJie Central Gymnastic
Institute, l8lj, and the Gymnastic Orthopedic Institute, 182J,
in ivhicJi Ling s Medical Gynuiasdcs has been chiefly developed.

In l8S7 ^^- ^' ^^.nder began the development of Medico-
[mechanical Gymnastics. In consequence of the excellent work of
Zander himself and of several of his pupils, the mechanical
method of Gymnastics has been more scientifically developed
than has the vieinual, although the latter method has benefitted
by Zajider s leork, since both systems are based upon the same

Major Thure Brandt is another distinguished pioneer in the
annals of Medical Gymnastics, ivJio as early as 1 86 1 introduced
the system for the tiratment of uterine disorders.

As advocates of Manual Medical Gymnastics may be
named, in the very first place, Drs. Herman Saiherberg atid T. J.
Hartelius, both of zvhom have zvritten extensively upon the subject.

The need of a complete Jia7id-book of Medical Gymnastics
has long been felt. New medical theories are put forth every
year and it is 7iecessary for the practising gymnast to pay atten-
tioft to them, if he is to keep pace with this restless progress. It
is by no means a light task to write a hand-book of Medical



Gymnastics and for this reason especially y that the wider the
sphere of activity Medical Gymnastics has obtained during the
course of time and will continue to gain, in the treatment of a
number of various diseases^ the greater will be the knowledge
and study of modern Medical Literature required o?i the part of
the author if he shall at all satisfactorily carry out his task. It
is not for me to decide in what degree my book will supply the
want I consider to exist for such a worky but it is my hope that
both gymnasts and medical students will find it a tiseful supple-
ment to their previous knowledge. The persons last mentioned
have already seen the necessity of a knowledge of the employment
of Gymnastics and have themselves demanded the instruction
which is now given on the subject at the Medical High-schools of
Stockholm and Upsala.

A great number of foreign physicians have also visited
Stockholm during the past twenty or thirty yearSy in order to
study at the Gymnastic InstituteSy so thaty as Dr. Zander once
remarkedy " we Swedish physicians repay y by means of our Gym-
nastics y what we have formerly obtained from abroad in other
branches of medicine. "

In order that gymnasts may have still greater use of my
worky I have thought myself obliged to insert the description of a
number of cases of illnesses which have been treated by means of
Medical Gymnastics y and as a consequence of thisy the work has
attained dimensions considerably larger than those originally
intended. Here and there I have been obliged to touch upon
Massage and Orthopedics in connection with gymnastic treatment.
In many caseSy especially in diseases of the joints y Massage must
be used as well as Medical Gymnastics; it iSy moreovery almost
impossible to make any clear distinction between Medical Gym
nasties and Massage. Orthopedics iSy in many caseSy the best
remedy in the treatment of bodily deformities and of certain
forms of nervous diseases. I have wished to draw attention to
this importance of Orthopedics for the reason that gymnasts need



to be made acquainted with the necessity for its use. Medical
Gyjnnastics does not exclude tJie simultaneous use of other reme-
dies and its therapeutical value is not lessened by the fact of
other means being employed,

And^ finally y it is a very great pleasure — an obligation — to
here express my warmest thanks to several of my esteemed col-
leagues in Stockhohuy as well the clinical doctors as other special-
ists in various branches of medicine^ for the opportunities given
me to treat cases of any greater interest and also for their great
zvillingness to examine such cases where there was any uncer-
tainty as to the correct diagnosis,

Stockholm, March, l8gg.



The classification of gymnastics,

Gymnastic apparatus,

" terminology,

The education of a gymnast

Gymnastic positions,

Fundamental positions,

Gymnastic movements, .
Free-standing movements.

General rules for gymnastic treatment.

Gymnastic prescription and daily treatment,
The respiration during gymnastic treatment,
Amount of time sufficient for the gymnastic treat


The gymnast's position and relation to the patient,

Diseases of the circulatory organs,
" of the respiratory organs,
** of the digestive organs, .

Diseases of the liver, ....

Diseases of the genito-urinary organs,

Diseases of the kidneys, .
of the bladder,
" of the male genital organs, .














Diseases of the nervous system, . . . . 240

Peripheral nervous diseases, 250

Vasomotor and trophic neurosis, . . . .260

Diseases of the spinal cord, 261

Cerebral diseases, 270

Neurosis without any known anatomical causes, . 270

Diseases of the muscles, 275

Constitutional diseases, 279

Diseases of the bones and joints, 286

Spinal curvatures, .313

Dietetic gymnastics, . . . . r 366



P. H. Ling classified and defined Gymnastics in the fol-
lowing manner:

i) "Pedagogical Gymnastics, by which we leam to
place our body under our oivti control.'' Pedagogical Gymnas-
tics is often called Educational Gymnastics, sometimes simply
''Gymnastics," and many of its forms of movement are also
used in Medical Gymnastics. It is the basis of all Gymnastics,
so that a special knowledge of the same is of importance to
each practitioner of Gymnastics ; it is besides entirely through
Pedagogical Gymnastics that we best develop our own body.

2) " Military Gymnastics, by which we try, through
some object exterior to ourselves, i.e. weapons, or by our own
physical power, to subject a secoiid exterior will to our own
will " ; thus including fencing or bearing of arms in general.

3) "Medical Gymnastics, by which, either alone, in a
suitable position, or with the assistance of others, we try by
means of influencing movements to alleviate or overcome the
sufferings that have arisen through abnormal conditions. "

4) " iEsthetic Gymnastics, by which we try to physically
exemplify our inner being — our thoughts and feelings."

It is not uncommon to divide Gymnastics into Free Ex-
ercises and Exercises with Apparatus, besides which the
different apparatus form the basis for further divisions of
movements, but as the most varying movements can be per-


formed by means of one and the same apparatus, such a di-
vision is unsuitable. The same basis for division is adopted
when classifying Medical Gymnastics as :

Manual- and Mechanical- or Machine-Gymnastics ; the
meanings of which terms are self-evident.

Free-standing movements, or free movements in Gym-
nastics, ought not to be confused with Pedagogical Gymnastics.
It is clear that free-standing movements can be used in Peda-
gogical as well as in Medical Gymnastics. The same applies
to apparatus exercises.

The terms Dietetic- and Exercise-Gymnastics are also
easily understood.


The different kinds of movements which are used in
Ling's System of Medical Gymnastics are divided into Active,
Passive, and Duplicated movements.

For the attainment of greater clearness in regard to the
physiological action of a muscle during different movements,
which is of importance in teaching, the following arrangement
of the various kinds of movements has been used: ^

I. Active Movements are divided into:

1. Free Active Movements

2. Resistive Movements.

a) SJior t cuing moveincnts^ or concentric movements.

b) LengtJicning movements., or excentric movoiuiits.

3. Gymnastic Holdings.

II. Passive Movements are divided into:

1. Passive Movements with some part of the pa-
tient's body.

2. Passive Movements on some part of the pa-
tient's body.

' The above arrangement of definitions is worked out with the help
of J. E. Johansson (Professor in Physiology in Stockholm), who has carried
on a series of experiments concerning the muscle work of the human body
which work has only been published in part up to the present date.


J^ An Active Movement is any kind of movement
which produces any muscle action on the part of the patient.

1. A Free Active Movement is a movement which the
patient performs by his own force and of his own free will.

In this case we have 2i positive muscle action^ the muscle is
shortened and performs an external positive work. Under
this description are included all the movements in Pedagogical

2. A Resistive Movement, also termed a Duplicate
Movement, may be performed in two different ways:

a) TJie patient performs the niovenieiit 7cJiilst the gymnast
gives resistance in proportion to the strength of the patient and
the desired result.

Even in this case a positive muscle action occurs, the
muscle shortens and performs an external positive work. The
movement is best described as a shortening movement^ it was
called duplicate-concentric and active-passive by Ling.

b) The gymnast performs the movement witJi a part of the
patient's body whilst the patient makes resistance. In this case
occurs a negative muscle action, the muscle is in a state of
contraction through lengthening, and instead of the muscle
performing, as in the former case, an external work, in this
latter instance a certain amount of energy is conveyed to the
muscle (Johansson). The movement is best described as a
lengthening movement ; was called duplicate-excentric and pas-
sive-active according to Ling.

3. Gymnastic Holdings are placed in the Swedish Gym-
nastic System as movements. In this case a static muscle
action occurs. The muscle is in a state of contraction, with-
out becoming either shorter or longer. No movement proper
takes place, and no motion is either performed by the muscle
or any energy conveyed to it.

Various muscle groups are found to be in a state of static
contraction, where the balancing or fixing of one or several
parts of the body is concerned, especially in producing correct-
ing (starting) positions in the treatment of lateral curvature of
the spine, of which more will be said under the description of
their treatment.


From the above-mentioned definitions of movements it is
evident that resistive movements and holdings are of a dif-
ferent character from free active movements. The difference
is that in free active movements, lengthenings, movements,
and holdings, the patient himself determines the strength of
the movements, whereas, on the other hand, in shortening
movements, as in the passive, the gymnast decides the

When the terms concentric and excentric are used in
Gymnastic terminology in connection with the above-named
movements, the movement is not regarded in relation to the
joint, but to the muscle or muscle group itself, which is active
during the movement, and with the "centrum " as imagined in
the middle of the muscle. Thus, for example, a concentric
movement is performed by the biceps brachii, when flexion
takes place in the elbow joint, whilst the gymnast's resistance
is placed on the flexor surface of the patient's forearm ; if the.
gymnast with the latter grasp stretches the patient's bent arm
whilst the patient offers resistance, an excentric movement
occurs in the same muscle.

IL A Passive Movement occurs when one or more gym-
nasts perform a movement with or on some part of the patient's
body, without the patient giving resistance or resisting in the ex-
ecution of the movement.

Thus under the term *' Passive Movement," Swedish Med-
ical Gymnastics include, not only movements executed with
part of the patient's body, but also on it, and this has held good
ever since Ling introduced his system. Some authors have
lately tried to set up a distinct limit between Medical Gym-
nastics and Massage, and for this reason declare that move-
ments on the patient ought to be assigned to massage, because
no joint movement is performed with the patient, neither does
he -himself perform any such, which is of course true if one
keeps to the strict sense of the word. Such an utterance, how-
ever, only shows ignorance of Swedish Gymnastics, and I find
no reason to question Ling's classification.

I. Passive Movements with any part of the body in-
clude all so-called joint movements which the gymnast per-


forms witJi some part of the patient's body while the patient is
passive, and are styled Passive joint movements.

2. Passive Movements on any part of the body which
include all the movements which the gymnast performs on any
part of the patient's body while the patient is passive, are
styled passive hand-grips, or Gymnastic massage manipula-
tions (Zander). To Ling's System is thus enumerated Hack-
ings Clappings Beatings Kneading^ Sawiiig^ Pressings Shakings
Vibrations Strokings Friction ; under these movements can also
be included all used massage hand-grips.


are not absolutely necessary to the practice of Medical Gym-
nastics. Only the most necessary are given here, as well as
measurements for the sizes which gradually acquired experi-
ence has proved to be most advantageous (see illustrations in
the plate)

High Plinth.' Two or three different kinds are usually
used and for different purposes.

Dimensions in centimetres

No. I Fig. a. No. 2 Fig. b. No. 3 Fig. c.

Length 115 130 115

Height 75 78 65

Width of seat 35 44 35

Width on floor 65 70 65

Width of foot-board 18 20 18

Height of foot-board from

floor 34 22 22

Plinth No. I is used to advantage in giving trunk move-
ments to children and in the treatment of spinal curvatures.

Size No. 2 is used in giving the above-mentioned move-
ments to adults, and, in general, when a patient shall take the
lying position on high plinth.

High plinth of size No. 3, on account of being lower, is

• By this is meant a kind of wooden bench, of the dimensions, given
above, on which the patient is placed.


best suited for chest-liftings, double arm-rollings etc. If only
one high plinth be desired, size No. i should be selected.

Low Plinth consists, as fig. d shows, of a back-support
which, in relation to the proper seat, can be placed at lo — 12
different heights between the vertical and horizontal positions,
by means of which the patient can take sitting, half-lying or
lying-position. Besides this, in front there is a movable foot-
board adjustable at different distances, against which the legs
can be supported in different positions. Supports for the arms
belong to the complete outfit of a low plinth but are not abso-
lutely necessary. The size that has proved to be the best is
the following: Length of seat, 50 ctm. ; length of back-sup-
port, 75 ctm. ; width of plinth, 52 ctm. ; height of seat from
floor, 38 — 46 ctm. ; length of plinth on floor, 72 ctm. ; length
of foot-board, 30 — 50 ctm. ; height of arm-support, 25 ctm. ;
length of arm-support, 55 ctm.

Boom (bar), fig. e, should be adjustable at 20 — 25 different
heights, at distances varying between 50 — 150 ctm. from the
floor. The boom can be made of an ordinary plank w^hen it is
used only for the leg lean-standing position, but it is better
that the upper part and sides should be stuffed and covered.

Heave-plank (in construction resembling the boom) or
Trapeze, fig. f, is generally adjustable at different heights,
but this is not necessary, as the patient can easily mount a
stool to reach the apparatus.

Rib-stool, fig. g, and Peg-post, fig. h. The peg-post
generally reaches from the floor to the ceiling but the rib-stool
is only about 250 ctm. from the floor, or so high that its top
rib can be reached by a full-grown person in stretch-standing
position. The distance between each peg or rib is from 10 to

15 or 18 ctm., their thickness such that the patient can conven-
iently clasp them with the hands.

Poles, fig. i, should be round, with a transverse diameter
of 6 — 8 ctm. and a height of about 250 ctm. It is of advantage
to use three poles, one of which is fixed, the two others mov-
able, and so arranged that at the top and bottom they are


united by a cross-bar at a distance of about 70 ctm. from each
other, and furnished with pulleys running in grooves.

Ropes of 5 — 6 ctm. in diameter can, if necessary, be used
instead of poles but are otherwise unnecessary in Medical

Table, fig. k. For this a high piano-stool (Vienna model)
is used that can be raised. It is employed for arm- and hand-

Stools, fig. 1, simple but firm and without backs, should be
found in sufficient numbers in a Medical Gymnastic Hall. It
is most advantageous to have stools of different heights suit-
able to different ages. Size of seat should be 40 ctm. square,
height of stools respectively 30, 36 and 42 ctm.

Foot-stools, fig. m, 22 — 25 ctm. in height, 50 ctm. in
length and 25 ctm. in width, should also be found in sufficient

Forward-drawing -ropes, fig. n, about i metre long and
furnished at both ends with wooden-handles.

Rods, fig. o, round, 3 ctm. in diameter and of different
lengths; for example, 30, 45 and 70 ctm.

Cushions, fig. p, 40 and 50 ctm. square, are used in the
fundamental kneeling-position on the floor, and in supporting
the backs of children when placed on the low-plinth when the
gymnast wishes to diminish the length of the seat.

One part of the apparatus here mentioned should be
stuffed and covered, namely, the high and low plinths, boom,
table and a few stools. Hard-stuffing is best and the covering
of shag in some dark colour. The advantage of using plush
is, that the patient can be better fixed upon it, while on the
other hand, if the apparatus be covered with smooth material
or leather, he can easily slip out of position when performing
the movements.



has not been subjected by me to any essential changes but is
employed as sanctioned by long usage in Swedish Gymnastics.
This is of importance also from the point of view that full con-
formity, as far as possible, should prevail between Pedagogical
and Medical Gymnastics. The Swedish Gymnastic terminology
has been decried by many writers and several have attempted
to change it but have, however, as yet, not succeeded, probably
chiefly for the reason that in reality it is so simple and clear,
that no very great improvement could be effected. The prin-
ciples on which the Swedish Gymnastic terminology is based,
are recognized as excellent by everyone who takes the trouble
to become familiar with them, since the terminology gives
briefly not only the movement to be performed, but even
names in detail the position which shall be taken for it, where
other Gymnastic systems use circumlocutions, and — observe —
all this in the Swedish terminology is given in most cases, in
one single line. Besides, the Swedish denominations for the
different forms of movements have already found their equiva-
lents in most foreign languages ; this has easily been accom-
plished in the Germanic tongues but meets with more difficulty
in the Romanic. There are, however, in the Swedish Gym-
nastic terminology a few expressions never otherwise used in
the Swedish language, so that there is every justification in
attempting improvements whenever quite fully clear Swedish
words can be used. The most commonly used expressions
which can not be understood without an explanation, are the
following : —

"Grasp** — is an expression much used. It means that
the patient takes hold of some instrument or, in absence of
this, the hands of a gymnast (see fig. 25)

" Stride ** — signifies that the feet are placed at a distance
of two foot-lengths from each other (see page 30).


" Lean " — signifies that the patient supports some part of
his body against a wall, boom, or other apparatus, for example,
arm-lean, side-lean, hip-lean, back-lean, chest-lean; in leg-
leaning the heels receive support from behind by means of a
"rib " or narrow plank fixed to the floor (see fig. 17).

" Lax " — signifies, in Gymnastic language, that the trunk
is bent forward and that the abdominal parietes are at the

Online LibraryAnders Gustaf WideHand-book of medical and orthopedic gymnastics → online text (page 1 of 26)