Negative effects of ‘W’ shape sitting position of children & its prevention techniques

  • March 30, 2016
W Sitting in Cerebral Palsy

Child sitting with the bottom on the floor and with their legs outstretched, forming a “W” shape is termed as W sitting. The negative effects of the W sitting position may not be seen after sitting once or twice, but changes and complications adapt in the musculoskeletal structures due to continuous adaptation of the posture while sitting.

Effects On Children Due To W Sitting

When a child adopts this posture the bilateral hip joints go for extreme internal rotation which develops extreme tightness of muscles lie inside called hip adductors and stretches the muscles over the abductor compartment. This extreme rotation can cause a knock-kneed position (genu valgus stress) and/or in-toeing of the feet (inversion). Apart from this, W sitting can be an indication of weak trunk muscles as this position allows children to adopt a stable base and use the ligaments around their hips for stabilizing themselves instead of using their core muscles resulting in core weakness.

How to break the habit:

  • When the child goes for W sitting, the child has moved into an alternate position. There are several options needed to adopt by a child-like: circle sits, ring sit, side sit, and long sitting.
  • Verbal cueing will be helpful by the parents or attendants to remind the child about the change of position
  • Normally the child adopts this posture while playing, if we provide seating options like a chair, the stool will be helpful to maintain the upright posture without losing balance, due to w sitting the children are mostly confined to play in midzone areas which limits the equisition of motor and cognitive skills.

Alternate Positions To Avoid W Sitting

  1. Tailor Position

In this position, the child truncal muscles are activated & engaged with head, neck, shoulders in the proper position for performing activities. Less strain over the joints of the lower extremity as the pelvis is more in the neutral position, the child can easily move into derived positions from tailor sitting to side sitting, quadruped, kneeling and half-kneeling. Once the child achieves tailor position one can target the child position challenging by making the child sit on Dyna disc under the bottom in tailors position.

Tailor Position

tailor Sitting on a Dyna Disc

  1. Butterfly Position

This position allows a more stable base to sit and allows good stretch for adductors of the hip

  1. Long Sitting

In this position, the child sits on her bottom with legs extended which creates a challenge for both trunk and postural activation and allows a good stretch for hamstrings which normally gets tightened

Long Sitting Position

  1. Kneeling

This position aligns the pelvis and rib cage more easily and very efficient position to stabilize the trunk by keeping back erect. Abdominals are engaged while maintaining this posture

  1. Half Kneeling

This position is a challenging position than kneeling which helps in teaching the balance reactions.

Kneeling and half kneeling

  1. Sitting On Bolster Or Peanut Ball

This position provides a stable base for a younger child, in this, the child adductors are stretched which are shortened due to w sitting

Sitting on Bolster

  1. Prone Lying

This position helps in stretching hip flexors and helps in upper limb weight bearing, stability over shoulder joint

Prone Lying position

Physiotherapy Management for W Sitting

Physiotherapy plays an important role not only in teaching alternate positions but also in treating the tightened structures upon assessment, core strengthening, back strengthening, balance training, functional training to perform activities of daily living.

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