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What is the Proper Positioning of the Hands and Arms in Optimal Standing Posture?

by Dennis Zacharkow, PT
© 2014

Proper positioning of the hands and arms can either facilitate or inhibit the elongation reflex of the body, especially in regards to a retracted lower abdominal wall and an elevated rib cage.

Alexander (1918) described three main stages in the natural positioning of the hands at one's sides, as an individual's posture progresses to most optimal.

Alexander's first stage is observed in many races at an early stage of development. These individuals usually stand with the upper body leaning back from the hips and a protruding abdomen. The hand position in this first stage of posture development is "with the palms of the hands forward, the elbows bent into the sides, the thumbs sticking out away from the body."

Alexander considered the second stage in posture development as characteristic of the average civilized person of his era: standing with the palms of the hands facing toward the body, the elbows facing back, and the thumbs facing forward.

In the classic physical therapy text Muscles - Testing and Function, Kendall et al. (1971) include this second stage of hand positioning as part of ideally aligned erect posture.

Acupuncturist Gokhale (2008), in her recent book, describes hand and arm positioning in good posture as similar to Alexander's first stage or second stage: "The arms are somewhat externally rotated so that the thumbs, or even the palms, face forward."

The hand and arm positioning in Alexander's third stage facilitates optimal reflex elongation of the body. The upper arms are rotated slightly inwards, with the elbows turned slightly outwards and away from the body. The back of the hands face forward (the palms are facing posteriorly), and the thumbs are facing the sides of the body.

Such a third stage arm posture will also help facilitate the proper position of the scapulae, which should lie "flat and widened across the back of the properly expanded chest" (Barlow, 1980).

Alexander's third and most advanced stage in hand and arm positioning is evident in a 1937 photograph of Joseph Pilates at age 57 (see Gallagher and Kryzanowska, 1999).


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