By Emil Zander.

I. Technique

The main principles in the technique of Swedish medical gymnastics are localisation of movement, i.e., to restrict it to a definite joint and group of muscles, and its graduation according to the strength of the muscles and the requirements of the individual case.

While Ling employed trained "medical gymnasts" to give the movements, i.e., the manual method, the medico-mechanical method founded by Dr. Gustaf Zander, so far as possible, while following the same principles underlying all medical gymnastics, endeavours to replace the gymnast by apparatus of a mechanical nature.

When a special active or passive movement is given, in most cases the role played by the gymnast is of a purely mechanical nature. In most cases the most suitable positions are decided once for all, and the direction of the movement is determined by the anatomical construction of the parts under consideration. In resistance movements the resistance given is of variable strength; on the one hand it must be given according to the physique of the patient, and, on the other hand, moderated, as we shall see later, according to the power of the working muscles in different parts of the movement. These two requirements, as we shall soon see, can be fulfilled with ease and with greater certainty by mechanical appliances.

On these principles, then, the mechanical method is founded, and the apparatus is constructed accordingly with a view to fulfilling the following requirements: -

(1) To maintain a correct starting position in the widest sense.

(2) To guarantee that the movement shall be performed in a correct anatomical direction.

(3) In resistance movements, to produce a resistance which on the one hand can be modified from the weakest to the strongest, and on the other hand to alter it during the movement according to anatomical and physiological requirements. Besides the apparatus used for movements the mechanical system comprises appliances constructed for special massage effects, such as hacking, kneading, stroking, and vibration, and apparatus for giving corrective pressure (orthopaedic apparatus). Finally, it comprises three machines specially devised for examining lateral curvatures.

Medico-Mechanical Gymnastic Apparatus.

The gymnastic apparatus constructed by Dr. Zander consists of seventy-three machines, and they are divided into the following groups : -

1. Apparatus for Active Movements.

A. Arm movements.

B. Leg movements.

C. Trunk movements.

D. Trunk-balancing movements.

2. Apparatus for Passive Movements.

E. Passive movements.

3. Apparatus for Massage Effects.

F. Shaking; vibration.

G. Hacking; beating. H. Kneading.

I. Stroking; rolling or light kneading.

4. Orthopaedic Apparatus (for Scoliosis).

K. Passive correction. L. Active correction.

The apparatus used for examining are : -

Trunk Measuring Apparatus

An instrument used for measuring the trunk to ascertain deviations of the vertebral column affecting head, trunk, etc.

Transverse Measuring Apparatus

An instrument for transverse measurement of the trunk, showing the shape of the chest at different heights.

An Examining Chair, the seat of which can be adjusted in different side-slanting positions to see their effects upon the spine.

To facilitate the writing of prescriptions and for the benefit of the patient each apparatus is numbered and lettered, the letter telling to which of the eleven groups the apparatus belongs, and the number its place in the group, e.g., Al = Arm-carrying-outward downward (with resistance).

In a text-book such as this it is neither necessary nor suitable to give a detailed description of all these various gymnastic or examination apparatus.* A brief description only will be given of the most important apparatus in so far as it is necessary for the reader to understand the medico-mechanical method of treatment.

1. Apparatus for Active Movements.

The manual method of gymnastics recognises two kinds of active movements, Free and Resistance (p. 157). For the former no apparatus is required. The apparatus for resistance exercises are the most important and characteristic of the medico-mechanical system, and consist of thirty-one machines (exclusive of those used for active orthopaedic treatment, which latter, for convenience' sake, will be described under that heading).

Besides the purely active form of Resistance exercises, the mechanical method uses two groups of movements, known as the half-active, half-passive exercises, which are not used in the manual method - viz., Pendulum movements, regulated by apparatus, and the sitting Trunk-balance movements, both of which forms have been introduced by Dr. G. Zander into gymnastic therapy; and are described as active because the patient is doing a certain amount of active work.

The apparatus for Active exercise is divided into three main groups : Resistance, Pendulum, and Trunk-balancing apparatus.

Resistance Apparatus.

To describe accurately the principles on which such apparatus is constructed it is necessary to recall such points in the physiology of movement as are of importance as a basis for these exercises.

In most active movements (not considering the muscle contraction of the antagonists) it is necessary to make a distinction between the muscles in primary and secondary action. By the muscles acting primarily we mean those muscles which perform the movement with motor contraction, positive (shortening) or negative (lengthening). The muscles acting secondarily are those which are required to fix the parts concerned by static contraction, e.g., in Arm-lifting-sideways the Deltoid contracts to raise the arm, and Serratus Anticus Major (with the assistance of others) is in static contraction in fixing the scapula, so that the acromion, the origin of Deltoid, is fixed and does not displace or annul the movement. If the arm be lifted from the horizontal to a vertical plane, Serratus Anticus Major is now the primary worker and contracts positively, and the Deltoid works statically to fix the part.

* Those who are interested may be referred to "Medico-Mechanical Gymnastics," a manual for teachers and patients of the Med-Mech. Institute, by E. Zander : Stockholm, 1899, price 1 kr.