Children with cerebral palsy, low muscle tone or other muscle or neurological conditions can have tight hip adductors, the muscles that pull the thighs inward. Tight hip adductors can make the legs scissor, or cross. Certain sitting positions tend to worsen tight hip adductors. If you have a child with cerebral palsy, conforming to certain sitting positions, along with other therapies, can help prevent permanent contractures or shortening of the muscles. Talk to your child's therapists or doctors about reinforcing positive sitting positions.
"W" Sitting
If your child "W" sits, he sits with his legs bent at the knees and his feet pointing back. His two bent legs form a "W." Children with poor upper body strength often sit in this position because it requires little upper body muscle to maintain, although normal children might also sit in this position because it allows free use of their hands and is comfortable for some. This position can worsen hip tightness because it places the hip adductors and internal rotators in a shortened rather than stretched position, physical therapist Jean McNamera explained in the 1995 issue of the journal "ADVANCE for Physical Therapy and Rehab Medicine."
Proper Sitting Positions
Children with tight hips should sit in positions that gently stretch the tight muscles and prevent further tightening. These include sitting cross-legged, also called Indian style or tailor sitting; sitting with both legs off to one side, as long as the child alternates sides; and sitting with legs stretched straight out, if possible. Your child can also sit in the ring position with his legs out to the front with knees bent and soles of the feet touching so that the legs form a "ring." Sitting on a low stool or cushion helps align the legs properly.
Consequences
"W" sitting can decrease use and development of upper body muscles and also tighten hamstring muscles. Your child's feet may also turn inward. Your child may have difficulty establishing a hand preference, because the "W" sitting position makes trunk rotation difficult. Instead of reaching across his body, your child will reach for items on the left with his left hand and on the right with his right, rather than developing a preference, according to McNamera. Over time, this type of sitting can cause hip dislocation. Proper postural management helps prevent hip dysplasia and hamstring and adductor surgeries down the road if your child has cerebral palsy or other conditions that cause hip tightness.
Making Corrections
Changing your child's sitting positions takes time and patience. Every time you see your child sitting in this position, correct him and place him in a proper sitting position. You may need to use supportive devices, such as something to lean on, or a table and chair to encourage proper positioning. Lying prone or on his side may also be a better position for your child. Work with your child's physical or occupational therapist or doctor to find ways to avoid potentially harmful sitting positions.
