Parents, caregivers, teachers, and loved ones of children, this post is for you. You can have a remarkable impact on a child’s hip health. Having a basic knowledge about pediatric anatomy, physiology, and biomechanics can help prevent injury or malformation of a child’s legs.
Because a child’s bones are considered “soft,” which means the epiphyseal plates have not yet closed (which happens during puberty and hardens the bones up), they are subject to torsion forces. W-sitting is a perfect storm for creating unnecessary long bone torsion, which can lead to something called excessive femoral anteversion. Excessive femoral anteversion is defined as an angle greater than 15 degrees, and measures the angle found between the femoral neck and the distal femoral condyles. This screen has also been called the Craig Test. (See the figures and video below)
See below and at this link for a demonstration video of how I and other healthcare providers measure for femoral version.
If the version angle is over 15 degrees (see the figure below), an adult can have hip dysplasia. To be clear, infants are born with a natural femoral version angle of 30 degrees. However, this angle shifts and diminishes in children, peaking at ages 4-6 and diminishing thereafter. Children with angles that do not normalize may need surgical intervention. This is because the femoral head is generally not well protected and the hip joint becomes vulnerable and easier to injure, as well as unstable.
Females have twice the risk of dysplasia as males, and toddler girls have a higher risk of excessive anterversion than little boys. This means women and girls have an overall shared higher risk. This is where W-sitting becomes an issue.
W-sitting becomes even more important for developing girls to avoid. But regardless of gender, W-sitting has been shown to delay normal gross motor development in babies and children, and also delay development of fine motor skills.
My own third child was born with a big inclination to W-sit. Researchers do not know if the likelihood of W-sitting is linked genetically; however because I grew up W-sitting, and my first two children did not, I could only suspect there could be a genetic link when my youngest son started to W-sit as soon as he could barely attempt sitting.
When he was young, my son learned the phrase “no ouchy legs,” and he eventually learned to self-correct. I visited every preschool he attended in order to talk to the teachers about protecting children’s long bone development, which was always well received. Even my older two children helped guide my littlest out of W sitting by using the same phrase. “No ouchy legs, James,” they would say, and he would self-correct and choose a healthier sitting posture.
Today James shows no residual ability or inclination to W-sit. He also has lost the hypermobility at the hip, knee, and foot that was developing as a result. In short, his long bones are developing nicely and without long-term repercussions.
That is not the story with other children who I have seen that were allowed to chronically W-sit as their primary means of sitting. The KEY PHRASE here is chronic or persistent. An occasional W-sit would not create long-term problems. The issue comes when a child’s dominant and chosen sitting strategy is to W-sit. Just like an adult who may slouch while on their phone or while seated, it isn’t the slouching that’s bad in itself, it’s chronically sitting that way that can cause issues.
Some of the problems associated with chronic and persistent W-sitting as a child include:
- Hip instability
- Trunk instability
- Knee and ankle instability
- Gross motor skill developmental delays
- Fine motor skill developmental delays
- Delays in hand preference development
- Gait (walking) & balance delays
- Excessive femoral anteversion leading to hip dysplasia (upper leg malformation)
- Tibial torsion (lower leg malformation)
- Underdeveloped core and balance musculature
- Mid-line crossing, trunk rotation and stability
W Sitting can also contribute to orthopaedic problems such as:
- Intra-articular hip damage – Hip dysplasia, Acetabular /cartilage labral tears
- Extra-articular hip and leg contractures/muscle shortening/atrophy
- Knee pain and/or Knee cartilage/meniscus problems
- Low back pain, sacroiliac joint, and/or pelvic pain
The solution is simple:
There are many preferred sitting postures you can encourage a child to take instead of W-sitting. See the gallery of photos below for healthy sitting options that encourage development of both gross and fine motor skills. These include:
- Cobbler sitting (ring-sitting)
- Tailor sitting (criss-cross-applesauce)
- Staff (long-sitting)
- Mermaid (side-sitting)
- Tall Kneeling
- Thunderbolt (sitting straight back on the legs/heels)
Happy healthy sitting for long-term hip preservation!
- Change of Femoral Anteversion Angle in Children With Intoeing Gait Measured by Three-Dimensional Computed Tomography Reconstruction: One-Year Follow-Up Study. February 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852217/
About the Author
Ginger has spent 20+ years helping people (mostly moms!) with chronic pain as a physical therapist, athletic trainer, and professional yoga therapist. Ginger is the author of Medical Therapeutic Yoga, now in its 4th foreign translation, founder of ProYogaTherapy Institute, codirector of Living Well Yoga in Healthcare, and most recently ran for State Senate in NC.
This and all blog posts related to yoga and/or physical therapy on www.gingergarner.com are not a substitute for medical advice and are not a prescription or program for individualized physical therapy. You must seek the advice of your health care provider and, only after a thorough physical examination and clearance, participate in any movement or exercise program.
All photos: ©2019. Ginger Garner. All rights reserved.