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)
