W-Sitting
W-sitting is when a child sits on the floor with their knees bent and feet positioned outside of their hips. When observed from a bird’s eye view, the legs and body create the shape of a “w”.
Signs and Symptoms
Children may move in and out of the W sitting position, but prolonged sitting places the child at risk for issues such as:
- Hip dislocation: results from a strain on the hip joints, increasing the likelihood of dislocation
- Decreased core strength: minimal activation results in poor development which may affect their ability to perform other gross motor tasks
- Increased muscle tightness: evidenced throughout the hips, knees, and ankles
- Increased likelihood of knee pain over time
- May contribute to in-toeing (feet turned inwards)
How Physiotherapy Can Help
- Suggesting alternative sitting positions to the W sitting pose: bum sitting, “criss-cross” sitting, sitting with the legs in front, side sitting, sitting on a little stool/bench/chair
- Transitioning from positions such as 4 point/crawling into a bum sit. This re-wires their motor pattern to help them automatically sit in different positions to avoid the W sitting position.
- Core/trunk strengthening – this can reduce the need to form the W sitting pose as strengthening the core/trunk muscles can make it easier to sustain other sitting positions that require more core activation (such as bum sitting, and long sitting)
- Hip muscle strengthening can help counteract the less optimal hip/pelvis alignments associated with W sitting, such as a posterior pelvic tilt and femoral anteversion. The gluteal muscles are commonly weaker in kids that W sit, and strengthening the hip extensors, abductors, and external rotators can help offset the consequences of less optimal alignment
- Muscle stretching/improving flexibility can make it easier to sit in other positions that require some flexibility (e.g., hamstring flexibility is needed for long sitting, and adductor flexibility is required for sitting crisscross). Hamstring tightness can pull the pelvis into a posterior pelvic tilt, so we can reduce that pelvic position by stretching the hamstrings.
- Practicing motor plans that allow children to transition easily from walking or crawling into other sitting positions.
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