Posture & Core stability: How and why these skills affect your child’s health, learning, behaviour & future

The words, “sit up straight” bring back all sorts of memories from my childhood. Deportment badges and walking to class 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 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 having a good posture is so important to your child’s health, behaviour and learning ability and ways to encourage your child to “sit up straight”.

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 a child’s control of their 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.

Postural control is at its most efficient when: muscular and ligamentous tension is normal; strength of muscle groups is good, especially the core stabilisers; joints are properly aligned during activity and the brain is able to organise proprioceptive and vestibular information adequately. Many children needing writing, reading or movement therapy have underlying weaknesses in one or more of these areas and similarly, many teenagers and adults needing therapy for chronic low back pain also have underlying weaknesses in one or more of these areas. As a result of these weaknesses, one’s natural ability to maintain a “good” posture whilst sitting, standing or even playing a sport is jeopardised. Consequently, when one is not able to maintain an upright, stable posture, our ability to perform motor (movement) tasks adequately, is affected. Many children (and adults) who have any of these underlying weaknesses can end up with poor fine motor 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 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 they often become overweight (due to the unwillingness to participate in something-sport or exercise- they perceive themselves to be poor at). It is now widely accepted that having a poor posture can lead to back pain and it can also affect how a child concentrates whilst sitting at a desk or writing.

In order to have a good posture, 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 a good posture 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 a good posture, 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).

How to tell when postural control is inadequate?

How doesyour child sit and breathe whilst writing: are they over-stabilising peripherally? Examples of over-stabilisation are: the shoulder blades poke out like chicken wings, the child holds their breath whilst writing; they hold the pencil very tightly and press down hard on the paper or, conversely, press too lightly, because they are over stabilising at their shoulders.

All of these compensations induce early muscular fatigue, poor oxygenation, muscle strain and pain. This sometimes leads to homework conflicts with parents and a very frustrated, uncomfortable child.

Research at Ohio University has shown that maintaining an erect posture conveys confidence. Surely, this is an essential skill to teach our children so that they become confidence-exuding individuals? So, how do we do this?

 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). Research has shown that increasing P.E curriculum time an hour a day has no detrimental effect on academic performance, despite the reduction in hours spent on academic subjects. Two-thirds of UK adults are not getting enough exercise (CSP, Move For Health). And only 13%* of us know how much exercise we need to do (30 minutes per day for adults, 5 days a week and 60 minutes for children every day). So, what are we waiting for- scoot to school tomorrow, or park your car as far away  from the school gates as possible, rather than the other way around!

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.

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 children for sitting nicely at their desks, 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 become involved in Back Awareness Week. Be aware that a child may benefit from consulting a physiotherapist or OT, if they have writing difficulties or you have observed symptoms of postural inadequacies. And consider implementing a core stability exercise programme at the school for the children who are clumsy, low toned, poor posture or uncoordinated, such as Physifun’s programmes (www.physifun.co.uk/physifunpackage), so that they can strengthen their core muscles and improve their balance and coordination in a structured daily setting. 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:

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. Ensure that they eat whilst sitting with good alignment, feet supported and a stable base. 

Ways to encourage good posture in school-going children:

Reading at home : 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. Good alignment  enhances continuous fluent reading, self-correction, elaboration, expressive reading and they might be more  interested and enjoy  the task.

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.

Some facts to think about:

Up to the age of 4, physiologically “good” posture, is present. Postural decline starts with entry to school and most secondary school-aged children have poor posture (Fairbank etal, 1984; Nissien et al, 1994). Children sit average 35-40 hours a week and after 15-25 minutes, children need a movement break, otherwise concentration suffers (due to muscle fatigue and or pain) (Breithecker, D – Teaching with exercise). Back problems and postural problems are on the increase (Gardner et al, 2005) and over 50% of 13-18 year olds suffer from LBP (Jones et al, 2001). Carrying 15% of body weight can cause spinal damage (Korovessis et al, 2004; Negrini et al, 1999) and evidence has shown that adolescents carry between 10% and 33% (average 21%) of their body weight in their school rucksacks (Forjuoh et al, 2003). The average and maximum load being carried by children is equivalent to an 80kg man carrying daily a backpack with an average load of 17.2kg and a maximum load of 26kg. Would this be legal in an adult workplace?

References (still to be edited)

1.      Cliff, D et al (2010). Efficacy of a skill development programme in promoting motor skill proficiency and physical activity in overweight children. Journal of Science and medicine in Sport. Vol 12, Supplement 2, January 2010, Page e70  

3.      Hunt, L (2009). Core Stability on the curriculum. Frontline. October 2009, Page 15 

4.      Zachopoulaoua, E et al (2004). The effects of a developmentally appropriate music and movement programme on motor performance. Early Childhood Research Quarterly. Vol 19, Issue 4, 4^th Quarter 2004, Pages 631-642  

5.      Weikart, P et al (1995). Foundations in elementary education movement.  Ypsilanti, MI: High Scope Press

 6.      Spalding, A et al (1999). Kids on the Ball. Human Kinetics 

 7.      Ayres, J (1979). Sensory Integration and the Child. Los Angeles: Western Psychological Services

 8.      Sikirov, B.A. (1987) Management of Haemorrhoids - A new approach. Israel Journal of Medical Sciences: Vol. 23; 284 – 286  

9.      Mantle, J et al (1990). Physiotherapy in Obstetrics & Gynaecology 

10.  Dennison, P.E (1981). Switching on: A Guide to Edu-kinesthetics. Ventura, Califirnia: Edu-Kinesthetics.  

11.  Hillman, C.H, Erikson, K.I, and Framer, A.F (2008) Be smart, exercise your heart: Exercise effects on brain & cognition. Nature Reviews. Neuroscience, 9, 58-65. 

12.  Orton, S.T (1937). Reading, writing & speech problems in children, New York. Norton.  

13.  Sibley, BA & Etnier, J.L (2003). The relationship between physical activity & cognition in children: A meta-analysis. Pediatric Exercise Science. 15, 243-256. 

14.  Winter, B, Breitenstein, C, Mooren, F.C, Voelker, K, Fobker, M, Lechtermann, A, Krueger, K, Framme, A, Korsukewitz, C, Floel, A & Kncht, S (2007). High impact running improves learning. Neurobiology of Learning & Memory, 87, 597-609.  

15.  Richardson, A. J. (2006) Omega-3 fatty acids in ADHD and related neurodevelopmental disorders, International Review of Psychiatry,18(2), 155-172

 16.  Rogers, P.J., Kainth, A. and Smit, H.J. (2001) A drink of water can improve or impair mental performance depending on small differences in thirst, Appetite, 36, 57-58 

 17.  Cynthia Burggraf Torppa (2009) Ohio State University: Nonverbal Communication Commentary

 18.  Howard Jones, P. (2010) Introducing Neuroeducational Research 

19. Sugden, D.A. & Chambers, M.E. (Forthcoming). "Stability and change in childrenw ith Developmental Coordination Disorder". Child: Care, Health and Development.

19. Kirby, A. & Sugden, D.A. (2007). "Children with developmental coordination disorder". Journal of the Royal Society of Medicine, 100, 1-5.

19. Sugden, D.A. & Dunford, C. (2007). "Intervention and the role of theory, empircism and experience in childrenw ith motor impairment". Disability and Rehabilitation, 29, 3-11.

19. Sugden, D.A. & Kirby, A. (2006). "A moving child is a learning child". Child Care, 1, 13-14.

19. Green, D., Baird, G. Sugden, D.A. (2006). "A pilot study of psychopathology in Developmental Coordination Disorder". Child: Care, Health and development, 32, 741-750.

19. Smits-Englesman, B.C.M., Sugden, D.A. & Duysens, J (2005). "Developmental trends in speed accuracy trade off in 6-10 year old children performing rapid and discrete aiming movements". Human Movement science, 3, 1-11.

19. Sugden, D.A. and Chambers, M.E. (2003). "Intervention in children with DCD:the role of parents and teachers". British Journal of Educational Psychology, 73, 545-561.

19. Utley,A,Steenbergen,B. & Sugden, D.A. (2003). "The influence of object size on discrete bimanuakl co-ordination in children with hemiplegic cerebral palsy". Disability and rehabilitation, 26, 603-613.

19. Chambers, M.E. and Sugden,D.A. (2002). "The identification and assessment of young children with movement difficulties". International Journal of Early Years Educaton, 10, 157-175.

19. Sugden, D.A., Kirby, A., Chambers, M.E., Drew, S. and Jones, N. (2002). "Models of provision for children with DCD". Special, Autumn, 16-19