Monday, January 7, 2019

W-sitting in Children

W-sitting in children: A habit worth breaking?

“W-sitting” or “W-sit” is a term used to describe a sitting position in which a child sits on the floor with their legs forming a “W” shape on the floor (knees bent, legs rotated and facing away from the body).
When is it ok?
Children often move into and out of this position during play or when transitioning from crawling to sitting. W-sitting is OK and perfectly normal if used in this way. It temporarily widens the base of support, giving the child a greater sense of stability and balance during play.
When is it NOT ok?
However, this position should not be encouraged for prolonged periods of time during play as it will lead to future orthopaedic and musculoskeletal issues, affecting muscles and joints of the back and lower limb. Long-term W-sitting is NOT encouraged as it will make the child become reliant on this position for added trunk/hip stability to allow for easier toy manipulation and play. Their trunk muscles will not be activated sufficiently for them to learn and practice weight shifts during rotation and lateral (side) movements of the body.
W-sitters are often children with:
·        Low muscle tone
·        Hypermobile joints
·        Difficulty with balance
Side effects of W-sitting:
·        May develop sway back posture
·        Walk and stand with feet turned inwards
·        Weak trunk and low back muscles
·        Tight hamstrings and low back muscles
Why do children choose to W-sit?
In W-sitting the legs are rotated outwards and spread wide apart. This means that there is a larger base of support and hence less work required by the trunk muscles to stabilise the body. The trunk muscles are important for maintaining an upright posture and reacting to shifts in balance. Possibly these children have not developed sufficient trunk rotation (twisting) or lateral flexion (bending to side) for weight shifts and so relies heavily on the wide base of support for maintaining stability during physical activity and play.

Correcting the Habit
Often W-sitting becomes a habit very quickly and it is important to address it promptly.
Encourage other ways of sitting:
·        Cross-legged
·        Side-sitting with both legs out to one side (make sure they alternate the side)
·        Sitting with legs straight out forward as able (hamstrings can be stretched at the same time)
·        Sitting on a low stool or a cushion

 Exercises and Activities
1. Strengthen the trunk muscles
a) Side to side rotation: Lying on the back with knees bent, slowly rotate legs from side to side but not letting knees touch the floor.
b) Side-sitting transfers: Start with side-sitting on one side. Without using their arms, the child moves from side-sitting onto their knees, then transfer to side-sitting position on the other side. Repeat in the other direction.
c) Seated marches on swiss ball: Sitting on a large swiss ball, ask the child to lift one foot off the ground and then the other, alternating side to side similar to marching.
d) Reaching on swiss ball: Sitting on a large swiss ball, hold objects at different distances and heights for the child to reach out for. This will train their trunk muscle control and strengthen the trunk muscles.
e) Bottom-walking: Sitting on the floor with legs straight out in front, the child bottom-shuffles by lifting one side of their bottom off the floor and moving forward, alternating side to side.

2. Back strengthening/Hip and shoulder stability
a) Superman arm/leg lifts: With the child on all 4′s, you can get them to do alternate arm lifts, leg lifts or combined arm-leg lifts (diagonal) – whilst maintaining stability and balance at all times.
b) Walking on all 4′s: You can get the child to walk on all 4′s (like a dinosaur), by lifting both arm and leg from one side forward, followed by the other side. This will encourage the training of stability in the shoulders and hips.
3. Hamstrings Stretching
The hamstrings muscle group runs down the back of the thigh and is usually tight in W-sitters, as they prefer to keep their knees in a flexed position. It is therefore important to stretch these muscles regularly to improve their flexibility.
Some exercises can become games for children eg. to stretch hamstrings you can ask the child to walk their fingers down the front of their legs as far as they can, aiming all the way to their toes, keeping the knees straight. Or if they are in long-sitting position, you can ask them to walk their fingers down their legs over the stretched out leg, as far as they can to their toes and hold the position, counting together 1 to 10.

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