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What’s Wrong With W-Sitting?

Parents bring their kids in for a physical therapy evaluation for many different reasons, from toe-walking to neuromuscular conditions to decreased ability to keep up with peers. Regardless of the diagnosis, about 25% of my clients under 5 also present with w-sitting. When brought to the attention of the parents, typical responses range from, “I’ve never noticed that before; is that bad?” to“I w-sat as a child, and I turned out fine.” Physical therapists will most always work to correct this sitting posture and some of the underlying impairments. Here are some of the reasons w-sitting is not healthy for children.

What’s wrong with w-sitting?

  • Decreased Core Activation – Due to the wide base of support afforded with w-sitting, less coreWhat's Wrong With W-Sitting? muscle (trunk extensors and abdominals) activation is required to maintain position. This wide base of support also limits the child’s need to weight shift from side to side during play, resulting in decreased use of lateral and posterior balance reactions.
  • Poor Posture – “W”-sitting encourages excessive posterior pelvic tilt, which can result in slouching. Excessive hunching over results in minimal trunk extensor activation. This creates a cycle of poor sitting posture due to muscle weakness, resulting in poor sitting posture.
  • Pigeon-Toed (In-Toeing) Walking Pattern – Increased hip internal range of motion, decreased hip external range of motion, and hip abductor weakness can contribute to an in-toeing gait pattern. It should be noted, however, that some in-toeing gait can be attributed to femoral anteversion.
  • Decreased Trunk Rotation – Poor trunk extension due to posterior pelvic tilt can limit ability to turn trunk from side to side. This is important because decreased trunk rotation during play can impair the body’s ability to integrate left and right sides of the body, leading to decreased coordination
  • Delayed or Impaired Fine Motor Development – This delay is usually due to a combination of the impairments already mentioned above, such as decreased trunk rotation and poor core strength. These impairments can lead to decreased play involving midline crossing and poor development of bilateral coordination. High level fine motor tasks, such as fastening a button, requires a coordinated effort between left and right hands.

Click here to read more about w-sitting and the young child.

To help your child who ”w”-sits, please contact one of our physical therapists at North Shore Pediatric Therapy for a free screen.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Physical Therapy Posts

signs a child may need PT at school

Signs at School a Child May Need Physical Therapy

Teachers can be wonderful allies to the healthcare field. They spend up to 8 hours a day observing and helping children. Often times, they are the first to notice concerning signs, and when given the right tools, can direct parents where to go to get their children the help they need. Here a few signs teachers can look out for that would warrant a physical therapy screen.

5 Signs at School a Child May Need Physical Therapy:

  1. Unable to keep up with peers during recess or P.E – This may present as a child whosigns a child may need PT at school doesn’t follow friends onto the jungle gym or pulls themselves out of games of tag. A child would benefit from a physical therapy screen if they are unable to perform a jumping jack or skip forward.
  2. “W”-sits or props onto arm when sitting criss-cross – A child who sits in a “w” position or props onto their arm when sitting on the floor may present with weak core muscles. Weak core muscles result in a poor foundation for other fine motor skills, and may present in sloppy or slow handwriting, poor cutting skills, or decreased independence in self care tasks.
  3. Places both feet onto step when going up and down stairs – A child should be able to go up and down a set of stairs, without holding onto a handrail, by the age of 4. A child who presents difficulty, or immature form, during a stair task, may have lower extremity weakness, impaired balance, or developmental coordination disorder.
  4. Toe-Walking Toe-walking or early heel rise during gait (which may looking like bouncing while walking) can arise from a multitude of impairments including muscle tightness, core weakness, impaired balance, etc. Prolonged toe-walking may also result in any of the above, excessive falls, or muscle contractures.
  5. Poor sitting posture at desk – Poor posture may be a sign of decreased endurance of trunk muscles. Trunk weakness may also result in a poor foundation for fine motor skills, resulting in poor handwriting, decreased grasping ability, or decreased independence in self care tasks.

Click here to view our gross motor milestones infographic!

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!