Postural control: How and why it affects your child’s health, learning, behaviour & future – written by Tracy Prowse
The words, “sit up straight” bring back all sorts of memories from my childhood. Deportment badges and practising walking with a book on my head were all part of a normal school day for me. Today, however, we think of these memories with a smile on our faces and cannot imagine it happening in today’s schools. Sitting up straight at a dinner table doesn’t often feature, since many of us do not eat at the dinner table anymore. Instilling a sense or awareness of good posture in a child seems to have been abandoned, perhaps to the detriment of our children’s health. Nowadays, children are spending more time in a sedentary position than ever before, which should give us more reason to focus on posture, not less. This article aims to explain why being aware of your posture whilst sitting and standing is so important to your health, behaviour and learning ability and ways to encourage your child to sit and learn in an optimal way.
Postural control describes the way muscles work together to maintain and regain posture and balance, thus liberating our arms and legs to do other things. Gravity, our sensory systems in our joints and ears (proprioceptive and vestibular), our brain’s ability to perceive the information given to it from these sensory systems and our innate motor development (such as balance, coordination and core stability) are factors that influence the control of our posture. Postural control begins in the womb and becomes refined with each new learnt task. It takes 7 years of constant refinement to achieve automatic postural control and in order to be “writing ready” postural control has to be adequately consolidated and automatic. However, for some of us, this ability to control our posture is not automatic and perhaps was not ever consolidated as a child and there can be a number of reasons for this.
One reason is that some of us are born with what seems to be loose, floppy muscles and joints. The medical term for this is hypermobility, which means “more movement”. It is characterised by weakness or laxity (looseness) of the connective tissue in our body. Connective tissue’s function is primarily to support, anchor and connect various parts of the body and is found in muscle, ligaments, surrounding organs and even in bone. Therefore, if one is born with a predisposition towards connective tissue laxity, they don’t have a natural supporting and anchoring system to help them sit or stand or move efficiently. As a result, their muscles need to work a lot harder to support and move their joints and maintain a posture than someone else who was born with strong and taut connective tissue system. Children who have hypermobility often find it hard to maintain their sitting posture for very long and will constantly wriggle and move in and out of positions or wind their joints up to the maximum position so that they almost lock the joint. The reason is that the muscles do not need to work in this position because the joint is locked into a sturdy position. Typical postures would be to stand with their knees locked back, hips thrust forward and a larger curve in their lower back then normal. They also tend to sit in a “W-sitting” position or if they are at a desk, they will try and curl their feet under them or around the chair in order to gain as much stability as possible.
Another reason for not having automatic postural control is purely a lack of practice. Some children are not encouraged to sit at the dinner table and eat their supper or perhaps they were not interested in drawing or table top activities as a toddler and so it was never pursued further. The problem with this is that they never get to practice something which is absolutely fundamental to learning: the ability to sit at a desk for a prolonged period. These children will have weaker sitting muscles, standing muscles and writing muscles than a child who has grown up being encouraged to sit and do an activity (like scribbling, playing with play Doh, eating, lego, or whatever) for short periods-progressively getting to be longer periods-since the time they could sit.
Following on from this scenario, is another scenario where the child doesn’t seem to have the concentration or ability to focus on one thing for any period of time. Their attention is constantly moving from one thing to the next and they are constantly distracted by outside noises, textures, sights or whatever catches their attention. These children do not gain that automatic and consolidated postural control because their attention to the task of sitting has never been present.
Many children (and adults) who have any of these underlying issues with postural control can end up with poor fine motor (movement) and sometimes poor gross motor control. This means that they have difficulty with their handwriting and other fine motor activities, as well as on the sports field during ball games, balance activities or coordination activities like skipping, hopscotch, riding a bicycle. Unfortunately, these are the children who desperately need to practise their motor skills, yet, due to a feeling of inadequacy or difficulty in sport or handwriting, choose not to do these activities. As a result, the weak get weaker, (and the sporty get sportier) and these are the children who often end up with poor posture, bad backs and a poor self-esteem or self-efficacy, later on.
In order to have efficient postural control, the spine needs to be in alignment with the natural curvatures of the spine preserved, with a stable but dynamic base of support in the core musculature. This will free up the arms and legs with minimum effort. Having good postural control strengthens the core stabilisers (postural muscles) and inhibits the moving muscles (non-postural muscles). These moving muscles are often the culprits of those aches and pains one gets when one has a sore back or neck. The moving muscles often try and compensate for the lack of core stability or core support and they try and do the work of the core muscles. However, the moving muscles are made up differently with fast twitch muscle fibres and therefore they cannot sustain the types of demands that maintaining postures requires. This is why they often get tight and sore. They are unable to do the work of the postural muscles for a long length of time.
Having good postural control, whilst sitting, facilitates proper positioning of the writing arm. It enables a shift of gaze with minimal shifts in background posture (“fidgety” kids) and facilitates use of vision and reduces visual strain and increases alertness and oxygenation and prevents back pain (13% of children aged 10-16 have significant incidence of recurrent LBP) (Jones et al, 2001). So, how do we encourage good postural control in our children?
It is believed that physical activity helps trigger our postural muscles (core stabilisers) unconsciously. Thus, encouraging a child to do physical activity is a way of improving posture, since the core stabilisers are the muscles needed to maintain a good posture. Physical activity is proportional to IQ, achievement, maths & verbal testing (Sibley & Etnier, 2003) and research shows that aerobic exercise is beneficial on brain function which is important for education (Hillman et al, 2008).
Another easy way to facilitate good posture in children is to make sure that their feet are supported whilst sitting. The Erector Spinae muscles (in spine) are triggered by the sensors in the feet, so without foot contact, the spinal muscles have to depend on conscious control. It is essential that the child’s school desk is the correct size and that a child is sitting with a foot stool at the dining table. You will be amazed at our much longer your child will be willing to sit still at the dinner table. Sit with knees apart, feet on floor, elbow at desk level, rest forearms lightly on front table and use light support for alignment, in order to gain natural curves of spine. Imagine that you are pulling the top of your head to the ceiling. Size matters when selecting educational chairs and tables. Age and height considerations are often not reflected in furniture selection, and consequently the furniture is too big or too small. Furniture that does not fit the users will lead to restlessness and discomfort, resulting in a decreased attention span and the consequence is that one size of furniture will not fit all the pupils who use a classroom; they need furniture of different sizes or that can be adjusted to suit their varying dimensions. Desk and chair height needs to be measured for each child and schools need to make use of wedge cushions and writing slopes for the children who are not coping with the standard desk structure (the slope enables the child to keep their hand under the line of writing and the wedge assists the child to maintain a natural curvature of the spine, thereby stimulating unconscious core muscle activation).
Ways to encourage good posture in pre-schoolers are to avoid W-sitting. Encourage good spinal and joint alignment during play by using cushions, wedges, and playing in different positions, such as high kneeling, lying on their tummy, on all fours or standing. Make sure these pre-schoolers have an opportunity to practise the skill of sitting and building up their writing muscles by setting goals for them to see how long they can do it for. Ensure that they eat whilst sitting with good alignment, feet supported and a stable base, but also teach and instill an awareness of themselves, by being present in your mind with your child during these activities. In the same way that we need to build up the strength of the muscles, so do we need to build up the “strength” of our focus, attention and concentration. The only way to do this is to engage with your child with mindful awareness of the task you are both engaging in.
Poor posture not only leads to a bad back at a later age but even in the young it can have some negative effects with poor concentration, fidgeting and discomfort. Ensure your child reads in a supported position with good alignment or even allow the fidgety child to read with their books in standing on a recipe or music stand. He or she will be able to move around and fidget whilst reading. This will actually improve his or her concentration, rather than hinder it. Incorporating movement into the task of reading might make it more interesting and enjoyable for them.
Give your child a stable base of support with cushions under their arms, knees and head (either lying on a bed or well supported behind the back on the sofa); arms comfortably supported; both hands on sides of book; Fingers long and relaxed; plane of book and the plane of face parallel; Nose opposite the middle of the block of print being read to facilitate easy flow of eye movement across midline.
If we can increase our children’s awareness about their posture and give them responsibility for their exercise and postural habits, then we, as parents are giving them the best start possible to a healthy future.
Parents and teachers need to provide good role models to the children; not only with their own posture, but also, by the amount of exercise and activity that they do. Encourage your child to walk to school, by appearing excited at the prospect yourself. Schools need to educate teachers and children about good posture. Positively praise and reward children for sitting at their desks for a prolonged period (20 minutes maximum for a grade 1 child; 15 minutes max for a Grade R child) and build up to that goal. You cannot expect a child who has never sat down and completed the task of colouring in a picture in Grade R to then sitting at a desk I Grade 1 for 20 minutes. Persist and insist that they move about and have breaks throughout the day (send the fidgety child on errands- they will return more focussed and less disruptive), think about incorporating a 5 minute stretch programme into your school day, such as the Straighten Up UK programme (http://www.chiropractic-uk.co.uk/straightenup). Movement plays an important part in seating. Research has found that “a school in which movement is supported and encouraged has a positive effect on the learning ability and attentiveness of the children” (Dr Dieter Breitheckerxi). Commit to good posture at home and in the classroom and make correct sitting a key component of all tasks at the desk and try and encourage mindfulness or awareness in both you and your child regarding their ability to sit. Be aware that a child may benefit from consulting a physiotherapist or OT, if they have writing or movement difficulties or you have observed symptoms of postural inadequacies. And consider implementing a strengthening exercise programme at the school for the children who are clumsy, floppy, poor posture or uncoordinated, such as Physifun’s programmes (www.physifun.co.uk/physifunpackage), so that they can strengthen their core muscles and their moving muscles and improve their balance and coordination in a structured daily setting.
BSc (Physio) Hons UCT, MPhil (Sports Physio) UCT/SSISA
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