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W sitting - bad or ok??

Discussion in 'Pediatrics' started by SoulShine, Oct 17, 2017.

  1. SoulShine

    SoulShine Member


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    There is a large amount of debate about this topic online so I thought I'd bring it in here!

    My uni teachings were that is was detrimental for kids to W sit, possibly leading to life long issues (medial femoral torsion). At my kids' kindy it was not allowed as the teachers were trained to stop kids doing it. There are gov. publications online detailing why it's bad and shouldn't be allowed however there is a stated lack of evidence for the anti-W sitting position position!

    Has anyone found good quality research in this? I don't have access to quality journal publications.

    I suspect it's not something a single line approach can be taken - for some kids (especially younger ones, hypermobile ones) it's probably less an issue, for others might be a serious concern - especially as a symptom, in which case we probably shouldn't just beat it out of them but examine the underlying (potential) issues. Also how long and how often the position is adopted matters...

    Thoughts?
     
  2. efuller

    efuller MVP

    I'd never heard the controversy before. It is interesting to see it because when I was young, I was intoed and the Doctors told my parents to make me sit in that position. It really hurt when I tried. In later years I realized it was actually painful for me to sit in that position because I did not have to littleexternal hip range of motion to get my foot flat. I was curious and looked it up on line.

    A lot of that sounds like a bunch of crap
    "child’s hip and leg muscles becoming short and tight " Only if they never got out of that position. If the child gets up and moves into other positions, there is no reason to expect that the muscles will become tight. It might be that those that can sit comfortably in that position will tend to be more external than those who can't, but what comes first.

    "W sitting can increase a child’s risk of hip dislocation" Ok if you showed me a paper that prospectively asked this question, then I would believe it. You would think that it would hurt to dislocate a hip and sitting for prolonged periods in a position that was straining a ligament would be very uncomfortable. Only the insensate do things for prolonged periods that would cause damage. I still would believe this one if the papers existed.

    "When sitting in the W position, kids are unable to rotate their upper body" This one is comical. However, I do hate it when someone says that an assertion is stupid so I should explain why. There is some upper body rotation available in the spine. Yes if you are standing you can get more rotation if you use your pelvis over your femur. If a kid sees a candy bar that is out of reach of their seated position, they will just get out of that position and get the candy bar. The comments about limits the development of hand preference. Who ever said having a dominant hand was a good thing. As a podiatrist, many tasks have to be done with either hand.

    "W sitting makes it difficult for the child to shift their weight from one side of their body to the other" Duh. What percentage of life do kids spend sitting this way? During a day most kids will spend time in tasks that shift weight from one side of the body to other. e.g. walking and running.

    "W sitting does not allow the child to develop strong trunk muscles" But it does allow them to develop strong W sitting muscles.

    I will admit that I may have hit the one website that completely missed a valid reason for trying to prevent w sitting. However the reasons listed at this site seem ridiculous. If the kid has the hip range of motion to sit like that comfortably then I don't see why shouldn't sit like that. Anybody seen any literature on this?
     
  3. Stanley

    Stanley Well-Known Member

    From what I have found in 40+ years is that W sitting develops from one of two things. The most common is missing the sitting position (which should occur at 6 months and last for 2 weeks prior to crawling). The second (much less common) reason is late walking. The importance of sitting is that it develops coordination and balance around the hips. If sitting is missed, this is substituted by kneeling. Kneeling develops balance around the knees. When a child starts to walk, there normally is a reflex of sticking out the bottom to land on it when they lose their balance. When this is absent, the knees bend instead. The result is either falling backwards or landing on the knees and falling forwards from there. Prolonged kneeling (due to lack of proper sitting or prolonged kneeling due to delayed walking) leads to W sitting due to stretching of the structures that resist internal rotation. We see the clumsiness that is associated (but not caused) with internal femoral position. I have seen good success with simple sitting balance exercises (rolling a ball to different sides of a child seated on the ground, or chair dancing for older children). The positional changes gradually respond to stretching and gait plates.
     
  4. Cyberbarn

    Cyberbarn Member

    ""child’s hip and leg muscles becoming short and tight " Only if they never got out of that position."

    It is possible that the reason the child sits that way is also the same reason why the leg muscles are short and tight. W-sitting is a topic often discussed in conjunction with connective tissue disorders such as Ehlers-Danlos. Many of those children w-sit because they can. And regardless as to whether they W-sit or not, many will end up with tight leg muscles.

    "We looked for muscle, tendon, and aponeurosis retraction in the knees, ankles, and the soles of feet. In our population of 232 patients, we found a retraction of the hamstrings in 203 individuals (87.5%). Retractions of the triceps surae were found in 90.9% of patients, and retractions of the soles of feet were observed in 95.9% of patients."

    https://www.researchgate.net/profil..._232_cases/links/57976f5f08aed51475e6978c.pdf
     
  5. efuller

    efuller MVP

    Interesting. I think you are saying that the tightness causes the w sitting and not w sitting causes the tightness. I could see if someone had ligamentous laxity that caused a genu recruvatum that someone might constantly contract their hamstrings to prevent hyperextension of their knee. The contstant contraction could lead to tightness. Interesting thought.
     
  6. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Does sitting that way cause a problem? Or do they just sit that way because they have the range of motion that allows them to sit that way?

    Plenty of non-evidence based opinions. No long term study. I not convinced.
     
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