The Long Term Dangers of W-sitting

The Long Term Dangers of W-sitting

By Teri Roberts, DPT

Kids Place Owner and Pediatric Physical Therapist

One of the greatest milestones achieved during a baby’s first year of life is sitting.  This is an enormous progression towards independence for the child and the parent.  Sitting is typically learned around 5 months of age through “prop sitting,” where the child is placed in a seated position with their hands down in front to assist with balance.  At 5 months, babies do not have the postural control (balance) to sit without some assistance.  Between 6 and 8 months of age, babies can sustain a seated position independently.

There are many varieties of seated positions:

• Long sitting with feet directly out in front
• Ring sitting with legs in a ring position and feet either touching or slightly apart
• Tailor sitting or Indian style sitting
• V-sitting with legs straight like a V
• Side sitting when knees are bent and both feet are pointed to the same direction
• W-sitting when both feet are behind and legs look like a W

Throughout a baby’s normal development, each of these sitting postures is normal.  You will frequently see your child transition in and out of these sitting postures frequently as they lead up to independent walking. 

A Baby W-Sitting

Although I just stated that all of these sitting postures are normal, I want to stress the importance of children not excessively W-sitting.  W-sitting does not pose a long term concern if your child transitions in and out of the position smoothly and efficiently, and does not maintain the position during periods of seated play.  W-sitting regularly can cause secondary hip and knee problems during walking, seen through excessive inward feet because of the position of their legs and hips.  

Not every child who W-sits will acquire a skeletal or muscular problem; however, it is extremely difficult to change these impairments once they begin.  W-sitting limits the amount of rotation that is typical during play, creating a pattern that does not utilize good core strength.  To prevent any negative hip or knee changes and the likelihood of core strength concerns, encourage your child to sit with “feet in front”.

By the time your child is 15 months old, you should rarely see your child in the W-sitting position.  Children are very intelligent and the W-sitting position (if hip flexibility allows for it) is the easiest way to sit without using any core strength.  It allows children to “lock out” at the pelvis and play in a seated position with the least amount of effort.  Children that have lower tone and need to work harder to maintain a seated position choose to W-sit frequently. 

If you notice your child W-sitting too frequently, encourage a feet forward seated position.  You could also bring toys up to a taller surface so your child either has to sit and play on a chair or in standing to discourage the W-sitting position. 

If you spend over a week with cueing and changing environment of play and you still notice constant W-sitting, an appropriate recommendation is to have your child evaluated by a pediatric physical therapist.  The physical therapist will check the range of motion of the hips to make sure that your child has functional external hip rotation to allow for a comfortable tailor sitting.  The physical therapist will also check to make sure that the core strength is appropriate to maintain a seated position with feet in front for functional play.

AZOPT Follow Up: Rehabbing Major Knee Injuries

AZOPT Follow Up: Rehabbing Major Knee Injuries

ACL injuries are a scary thing to see when they happen to athletes on television.  We see them writhing in pain, clutching their leg with tears rolling down their face.  An ACL injury to an athlete is season ending, potentially even career ending.  The rehabilitation is gruesome, tedious, and long.  But professional athletes have teams of doctors, physical therapists, trainers, and coaches to help them get back to 100 percent.  Not to mention their rehabilitation becomes a full time job.  That’s why, over time, most athletes bounce back from major ACL injuries. 

What about the common, middle-aged, weekend athlete?  In February, we posted an article Everyday People: Rehabbing Major Knee Injuries with AZOPT.  In that blog we met Josh, who suffered a grade 3 tear of his ACL and MCL, along with torn meniscus and bone bruising while practicing Judo with another adult in his son’s class.  A 35 year old father of three, Josh was an active person who participated in CrossFit, Judo, bike riding, and golf.  Josh had successful surgery on January 14, 2013 to repair his torn ACL, and he began physical therapy at AZOPT on January 23, 2013 with Ryann Roberts, DPT and Owner.

We interviewed Josh upon completion of his physical therapy March 8, 2013:

Your first appointment following surgery was January 23, your last March 8.  What was the focus of your rehabilitation during that time?

I attended physical therapy three times per week during that time.  We focused on strengthening, stretching, and balancing.  Strengthening exercises included squats, first with both legs, and then one leg at a time.  I also did various lunges and calf raises.  Stretching exercises were aimed at regaining range of motion with physical manipulations, static holds, and soft tissue massages.  The balancing exercises helped improve coordination by standing on one leg and throwing objects, or rocking on a tilted surface.  With going to physical therapy three times each week, I was pretty sore.  At home I tried to get good rest and kept up with stretching exercises Ryann had given me.

How helpful was physical therapy?

Physical therapy was very helpful as the first part of my recovery process.  Physical therapy took me from barely being able to walk to now (May 1) re-entering CrossFit and engaging in fairly rigorous physical activity.

On March 8, at your last physical therapy appointment, how far along were you in your complete rehab?

My rehab was progressing along nicely.  I had just been cleared to return to jogging and strengthening exercises, but not athletic type movements.  At the time, I felt I was ready to go off on my own and continue to rehab.  Ryann had given me a thorough home exercise program that included strengthening, stretching, and balance exercises. 

As of today, how far along are you in your rehab process?

My doctor has just cleared me to gradually return to sport-like activities.  I am participating in a form of modified CrossFit.  My doctor has just cautioned me to proceed slowly as my strength and coordination return.

What do you feel, if any, is the difference in rehabbing your knee with Ryann as oppose to anywhere else?

Ryann was an excellent fit for me.  His own athletic background gave him a unique perspective to appreciate my goals.  His more than capable oversight helped me achieve my best recovery possible.  My doctor has told me my knee represents their hope in all patients and is a best-case scenario. 

In our first article, we talked about your mental state and how faith has played an important role in accepting this injury and moving forward.  Having gone through the rehab now, what can you tell others about your experience?

The last seven months have been an unexpected sequence of events beginning with my injury then dealing with the consequences of the injury including doctor's appointments, rest, rehab, surgery, more rehab, etc.  Each of these has been accompanied with frustration, inconvenience, monetary expenditure, and physical pain and discomfort.   That is the honest reality of getting your leg snapped in two.  However, with that said, the thing that stands out most clearly is how fortunate I am.  God has been good to me.  I have received constant love, care, and encouragement from my family.  I was blessed to receive exceptional medical care from my doctor and the team over at AZOPT, and I have been blessed by the time and place I live so that I now have a reconstructed knee.  Think about how incredible this is.  Doctors used a portion of my hamstring muscle to recreate ligaments in my knee and because there were only minor incisions paired with modern medical techniques I will have a knee capable of returning to play in the NFL--pretty good for a middle-aged guy who is just trying to keep in shape and have an active life with my kids!  I have a lot of which to be thankful.

May is National Arthritis Awareness Month

May is National Arthritis Awareness Month

By: Brooke Smith, DPT

Do you or someone you know have pain in their joints, but do not know the cause?  You may have symptoms of arthritis.  Today, nearly 50 million Americans suffer from arthritis.  Arthritis is often misunderstood as minor aches and pain associated with getting old.  However, there are many different forms of arthritis that can occur at any age.  Two-thirds of the population with arthritis occurs in people under the age of 65, including children.  The three main types of arthritis are Osteoarthritis, Rheumatoid Arthritis, and Juvenile Arthritis.

Osteoarthritis (OA) is the most common form of arthritis and is characterized by progressive degeneration of the joint’s cartilage, causing bone to rub against bone.  It most commonly occurs in weight bearing joints such as the hips, knees, and lower back.  OA has also been known to affect the neck, small finger joints, the base of the thumb, and the big toe.  Some of the symptoms include gradual development of stiffness within the joint, pain or joint soreness after overuse or inactivity, morning stiffness, and loss of motion/movement within the joint.  Several risk factors can lead to the development of OA including obesity/overweight, history of joint injury, overuse, genetics, muscle weakness, and age.   OA usually occurs later in life as a person ages.  It is described as the “wear and tear” of your joints, and the older you are the more you have used your joints, putting them at greater risk for OA.   However, older age does not mean OA is inevitable.

Rheumatoid Arthritis (RA) is a systemic disease characterized as inflammation of the joint lining causing pain, stiffness, warmth, and swelling that can occur throughout the body.  RA is symmetrical, affecting the same joints on both sides of the body.  RA affects nearly three times the amount of women than men and most commonly begins between the ages of 30 and 60 years old.  RA has no cure and progression leads to development of rheumatoid nodules and joint deformities.   Although there is no cure for RA, highly effective treatments exist including medications, physical therapy, physical activity, weight control, and maintaining good overall health.

Juvenile arthritis (JA) can have many different forms but is generally described as an autoimmune and inflammatory condition that can develop in children ages 16 years and younger.  JA affects the joints like RA and OA; however, it can also affect the eyes, skin, and gastrointestinal tract.  There is no known cause for JA, but it has been suggested that toxins, foods, allergies, or genetics can cause a child to develop the disease.  Symptoms are similar to RA and OA and include inflammation of the joints, pain, and joint stiffness.  It is important with JA that the entire family maintains a sense of calm and normalcy, as well as sticking to daily routines and comforting habits.  It is also important to address emotions of sadness, anxiety, and anger the child may have to help maintain the attitude that “arthritis is something I have to live with but not what defines me”.

               

There are options, other than surgery, to help improve your symptoms like stretching, walking, strengthening, Tia Chi, and physical therapy.  As a physical therapist, my goals in treating arthritis are to decrease the amount of pain, improve strength of muscles to increase stability around the joint, stretch muscles that are tight and might be hindering proper body mechanics, and improve joint protection.  It has been shown in recent research that exercising is a valuable tool in decreasing the symptoms of arthritis.  Some specific interventions that physical therapy might provide include modalities, braces and splints to protect joints, and hot or cold packs.  A physical therapist will work with you to modify your daily activities and your environment to provide pain relief and improve function.  Physical therapy will improve flexibility in your hamstrings, quads, calves, and hip flexors while strengthening the muscles around your knee, hip, and ankle.  Your appointments may also include coordination and balance activities.

               

If you or someone you know is experiencing any of the signs and symptoms discussed above, or has been diagnosed with a form of arthritis, you might think about scheduling an evaluation with a physical therapist to address your symptoms.  You can contact AZOPT at (623) 242-6908 if you have any questions or concerns.

For more information, please visit www.arthritis.org.

Child Development of Self-Care Skills

Child Development of Self-Care Skills
By Jessica Holyoke, OTR-L

Activities of daily living (ADLs) are a necessary part of our day and include various tasks such as getting dressed, bathing, brushing our teeth or hair, and feeding ourselves.  Most of us place very little thought or effort when carrying out these tasks, but how did we learn to perform them?  Throughout the first year of our life, we will begin to develop the skills necessary to take care of ourselves.  It is important that children have many opportunities to practice these skills.  This blog will look at the typical development of these self-care skills and give examples of how to encourage your child’s development.

Dressing

A 1 year old child has already begun to explore how to take off clothes by removing their socks and raising their arms to help get a shirt off.  Between 1 and 2 years old, your child will continue this exploration and learn to take off his or her shoes and socks.  They will also begin to help put their arms through holes and hold out their legs for pants.  Between the ages of 2 and 3 years, a child can remove simple clothing on their own.  They are learning to put on front closing tops (jackets, button-up shirts) and to unzip and unbutton large buttons.  By 4 years old, a child can dress and undress themselves with assistance for fasteners and ties.  By 5 or 6 years old, a child is nearly independent with dressing skills needing help only with difficult fasteners such as belts and selecting appropriate clothing to match the weather.

Bathing & Grooming

A 1 year old child is starting to become aware of cleaning themselves.  They can wipe their face with a napkin or towel (not completely).  They can grasp tools such as a toothbrush or spoon, and mimic movements that will develop into controlled use.  Between 1 and 2 years, a child begins to enjoy bathing and takes an interest in helping.  By 3 years, they are actively participating in washing and helping with brushing teeth.  At 3 or 4 years, a child can wash themselves with supervision and some help with hair.  A 5 to 6 years child should be able to complete bathing and grooming tasks on their own with occasional reminders to do a thorough job.

Toileting

When to potty train can often be confusing for parents.  Typically, the first indication that a child is ready to start potty training is their ability to indicate when they are wet or soiled, which typically occurs by age 2.  The next step is their ability to indicate needing to go to the bathroom.  A 3 year old child should be using the bathroom with daytime control, still needing help for wiping and managing clothing.  By 4 years old, a child develops nighttime control and needs less help with wiping and managing fasteners on clothing.  At 5 or 6 years, a child is independent with toileting tasks.

Feeding

Around 6 months, a child develops the upper body and hand strength to hold their own bottle.  By 7-8 months, they can grasp small pieces of cereal or baby cookies and bring it to their mouth. They may start using a spoon for feeding by about 12 months.  Between 1-2 years, a child is using a spoon (with spilling) and can hold and drink from a Sippy Cup.  Between 2 and 5 years, a child develops the ability to use a spoon and fork, and can drink from a cup with no lid (with some spilling).

The most important thing to remember about any skill development in childhood is that is takes time and lots of practice.  Spend time on these skills, especially in the evenings and weekends when there is a bit more time to spare.  Give as little help as possible.  As the child gets older, allow them to work through problems and give more verbal feedback than hands on help.  Children learn through play so turn it into a game.  You can play dress-up or dress a stuffed animal for dressing skills, play peek-a-boo games where the child pulls a napkin or washcloth off their face or head for grooming skills, and use spoons and other utensils while playing in pudding or applesauce for feeding and utensil use.  Give your child as many opportunities as possible to practice their skills, let them make mistakes, and have fun learning new skills.

It is important to remember that these skills develop at a different pace for each child and the ages presented are considered average.  If your child develops these skills slightly faster or slower, there is no need for alarm.  If there is a significant delay in the development of these skills, your child may benefit from an occupational therapy evaluation.  Please feel free to leave your comments in the section below if you have specific questions regarding your child.