If you have a child who loves that “w” position while sitting on the ground, chances are you’ve either corrected them yourself or heard someone else direct them to sit “criss-cross” or “fix their feet.” The challenge, however, is understanding why there are so many conflicting opinions on the matter. Is it really that bad? There was recently an article on Today.com titled “Why W-sitting is really not so bad for kids, after all.” Two orthopedic surgeons weigh-in on how w-sitting is a position that children sit in because their anatomy allows it, it feels comfortable, and when you should be concerned about it.
As a physical therapist, I felt it was important to address this article in a way other than pointing out our profession’s fears of w-sitting, which can be found in “What’s Wrong With W-Sitting?” and “W-Sitting and Your Child’s Growth.”
I want to acknowledge that, to some extent, I agree with this article. The anatomy, angles, and alignment of a child’s leg bones changes extensively throughout young childhood. Children do have more flexibility which can make w-sitting often a preferred position. And most often, prolonged w-sitting will not progress to the point of being a surgical issue. If your child only sometimes sits in this position and can easily move into and out of it, it is probably not a big deal. (Please note: as with the article above, I am generalizing this blog post. I am just discussing w-sitting and am not going to address the impairments that often result in w-sitting: low muscle tone, decreased core strength, excessive femoral anteversion, etc. Please speak with your pediatrician or see a physical therapist if you have concerns with your child’s development. Sometimes w-sitting is the result of other things going on which can impact their gross motor success.)
So—why do people like myself lovingly attempt to annoy your child out of w-sitting? It is not that physical therapists do not acknowledge the natural development of their anatomy and what feels best. It is that we are bombarded throughout our schooling, clinical experiences, and our entire professional careers of what occurs when muscles are not aligned “within normal limits.” For pediatric therapists, we are given this unique and wonderful opportunity to work with bodies who are just beginning their development, moldable, and are constantly changing to assess and promote optimal alignment- a strong foundation for a strong life. For me, it does not matter if your child is coming to me for shoulder pain- I am going to correct how their legs are positioned while they are sitting; posture is like the “eat your vegetables” and “brush your teeth” of my profession. I want each child’s physical growth and development to occur on top of the best possible foundation. Just as pediatricians and dentists want to establish healthy habits, routines, and lifestyles for short and long term health, physical therapists want to encourage the best posture for your child so that they will not be limited or suffer from the painful conditions or injuries that result from poor alignment and muscle imbalances.
An easy example to compare w-sitting to is poor sitting or standing posture. Almost all adults can relate to the neck and back pain that can occur from poor posture. In addition, poor posture can contribute to nerve impingement, shoulder pain/injury, jaw pain, sciatica, etc. This pain did not happen as your parents/grandparents/teachers/caregivers encouraged you to “sit up straight” or “stop slouching”—it happened later as the bad movement patterns continued and the muscle imbalances grew worse. In my mind, w-sitting is the same. It may resolve and you may never develop pain, or these movement patterns and muscle imbalances may progress; when you look at the alignment and muscle activation that w-sitting encourages, physical therapists think of the following (to name a few): patellofemoral syndrome, hip pain from impingement, flat feet and foot pain, knee osteoarthritis, and increased risk of knee and ankle injuries.
As the parent, how you use information is up to you. As a physical therapist, I will continue to kindly request that each child sits “criss-cross applesauce” for their current AND future development.
NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. 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!