'W-sitting position' in children with low tone

[sisone]

I want to ask the opinion about the W sitting position in children with low tone...i try to teach side sitting but all of them seem to like W and try to spend as much time as they can in this position ... I know that in W-position they have better support and that they don't need to use trunk muscles, also they don't need balance reactions because of the wide surface of support... My question is if it harms the hip and knee muscles or ligaments and if it's bad for the upcoming milestones...like quadruped, standing and walking... excuse my English... it's not my natural language... ty

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[PamVersfeld]

Hi Sisone

As you so correctly point out if a child sits in W-sitting she does not need to use her trunk balance responses. But she will also tend to develop tightness in the fascia lata and related myofascia. And these children develop external tibial torsion - the knee can rotate laterally but not medially. And this is one of the reasons the child does not like sitting cross legged - because thye do not have adequate medial rotation of the knee needed for cross legged sitting. if you as the child where thye are uncomfortable, they usually point to the lateral aspect of the lower leg.

The chances are that if the child has so called low tone she has hypermobile joints and muscle weakness. You cannot do much about the hypermobility - but muscles can be strengthened.

How old are the children you are seeing?

In my experience you need to practise sitting with the legs in front of the body and sitting on a chair.

If you tell me more about the children you are seeing, I can make some suggestions for training sitting.

But to answer your qustion - yes it does affect the child learning to sit erect with comfort and that becomes a problem when the child goes to school. It is also often associated with poor ability to stand on one leg and hop.

Best wishes

Pam

[sisone]

so i work in a kindergarden where i have 17 kids with special needs 2 to 8 years old...most of them diagnosed with CP:spastic dyplegia, quadruplegia, cerebelar ataxia, mental retardation, west syndrom, delayed development, low tone...
...im the only phisio in this institution and alot of times i feel the need to change opinions with somebody so thats why i think this forum its a great thing...ty for your reply and i would apreciate if u could give me some ideas on how to train sitting...
...my aproach on this matter is side sitting, cross legs ( which i find eficient where spasticity is involved) and also legs in front( here i wanna ask if legs should be extended or flexed in external rotation for more support).
...about W sitting, its about a girl, 7 years old with cerebelar ataxia...she always goes in W sitting...she can crawl...and now i work on balance with her on her knees... she can maintain the high position(knees on 90 degres) without suport and also she can move sideways in this position with suport(like hands on a wall)...she can pull to standing at furniture and maintain the standing position with support but without support there are no signs of balancing reactions...she just tends to fall, mostly backwards...im also working with her on the "big" phisyo ball, in sitting, where she has some balance reaction but she alwasys falls backwards...i hope you can get a picture from what i wrote here but im not used to physio english words yet...ty

[estherderu]

Hi Pam
welcome!

I hope to hear a lot from you in the future.

thanks

esther

[tyciol]

Is it really the discouragement which should be the issue, or is it moreso the encouragement of adopting an externally (aka lateral) rotated hip alignment too. Like encouraging sitting cross-legged is good, doing so stretches the muscles which internally rotate and adduct (I think transverse adduction more specifically) the hip muscles. Tightness in those muscles is likely the reason it's difficult to adopt this posture at first. Heck, we have this problem even as adults, how many of us can get out knees to the ground in a butterfly stretch?

I can see how this could be bad for the hips, it's a similar criticism to the hurdler's stretch in track and field. Even so, I don't think we should totally give up on it, just make sure people don't spend 100% of the time, because you can get the reverse problem where you have tight external rotator muscles. You could develope mobility problems later in life if you don't maintain the ability.

For example, on these A-Z tips right after the deadlifting videos there are a series of stretches for tight external rotators to retrain the ability to internally rotate the hip that we lose, perhaps because of our focus on negative avoidance of internal rotation rather than positive training of external rotation (which is incredibly important, this is correct, beyond mobility encouragement it helps with stuff like proper squatting posture, hip extensor recruitment, and if you want to do proper ballet turnout or side splits for martial arts without stretching improperly.).

These illustrations should begin roughly next to the 'I is for Integrity' section. There are 2 test pictures, 1 mobility video and 1 lying stretch illustration relevant to it. The actual section referring to it is 'Q' though not really needed (and I don't want the Stano shot annoying anyone)

Furthermore also the final picture on the right side of this article shows another example of an internal rotation stretch.

Sitting in W may be an unhealthy way to train internal hip rotation. It does look like it compresses the knees and I know personally I find it really painful. However, if a child is discouraged from sitting that way, I wonder if it might be beneficial to introduce some of these stretches as a means of making sure a reverse imbalance does not occur. When I tried them they were not painful like W sitting, I think because there is not weight on the knees so you begin rotation more from the hips just like we do with cross-legged sitting and butterfly stretch.

[estherderu]

dear Tyciol,

We are in the paediatric section here.

Your detailed reaction seems to address the adult situation more.
Your links seem to send us to a site advertising products.

Esther

[illuminatidinesh]

I want to ask the opinion about the W sitting position in children with low tone...i try to teach side sitting but all of them seem to like W and try to spend as much time as they can in this position ... I know that in W-position they have better support and that they don't need to use trunk muscles, also they don't need balance reactions because of the wide surface of support... My question is if it harms the hip and knee muscles or ligaments and if it's bad for the upcoming milestones...like quadruped, standing and walking... excuse my English... it's not my natural language... ty

Ya sisone wat ever u said is true, now it also important to know that W sitting leads to lack of lateral weight shift which is quite important during this period of development. And also it inhibits trunk rotation too that adds to misery.

[daniel_sadana80]

yeah... We must to change w position to be normal position. because in sitting if they sit in w position , they can't have good trunk control

[dr.dharakp]

hello..
i think we have to avoid w sitting because it leads to femoral anteversion, and medial hams tightness as well as illio-tibial bend tightness.