Postural strength may also be talked about as trunk control or core strength and is the foundation for children to be able to assume and maintain an upright posture while sitting or standing without support. It is the strength in their back and tummy that provides a basis of support which allows the arms and legs to move smoothly with good coordination (in PT school we called this proximal stability for distal mobility). The normal way to achieve postural strength is to help a child progress through developmental milestones without skipping crucial steps during the first year of life before a child progresses to independent walking.
Allowing a baby to have floor play time to learn to explore and move their body to get to where they want to go or to reach for a toy is so important and should not be replaced with the convenience of “container” toys and play equipment that restricts and can inhibit a child from using their muscles in a more natural way. This includes bumbo seats, exersaucers, jumpers, and walkers. It starts with tummy time with a baby learning how to lift and hold their head, propping on forearms and then their hands, weight shifting to reach for a toy with 1 hand, rolling, playing with their hands and feet lying on their back, propping in side-lying, prop sitting, army crawling, sitting and reaching for toys with rotating their trunk, pushing up to sitting, creeping on hands and knees, and pulling up to kneeling and standing. There may be various reasons why a baby may not be able to progress through some of these milestones but regardless it will lead to further weakness and can result in poor postural stability.
Weakness in postural muscles in children can be caused by:
Low muscle tone (hypotonia)
decreased core strength
generalized weakness
an inefficient vestibular system
I will just focus on core strength here with hypotonia and the vestibular system addressed in another article.
Why Is Postural strength important?
Postural strength is important for children because weakness in this area may result in:
Difficulty with moving in and out of various positions with ease
Difficulty with sitting on the floor or in a chair
Limited trunk rotation/mobility
Difficulty with fine motor skills-manipulating small objects, handwriting
Difficulty feeding self with utensils
Difficulty with using 2 hands during play
Decreased breath support for speech production
Difficulty with feeding and/or oral motor control
Difficulty with coordination activities such as running, galloping, skipping, riding a bike
Decreased body awareness
Classic signs of poor postural control include:
Sitting on a chair in a slouched position
Leaning far onto a table top to gain support while sitting
Frequent falls while seated
Difficulty on playground equipment such as slides, poles, seesaws, and swings
Difficulty participating in school sports
Walking with a wide base of support and sitting in a W-Sit wide floor position
Fearful of rough and tumble play
How Does Pediatric Physical Therapy Help With Postural Strength?
Pediatric Physical Therapists through evaluation and observation can identify postural weakness and provide exercises, positions, and play activities to help strengthen these muscles and educate the parent on how to implement good postural alignment during a child’s day and routines. I wanted to take some time to address a common “habit” seen with toddlers and children: W-sitting! Some babies continuously get into a “W” sit position, in which their legs go behind them with their knees in front with a wide base of support. Children who generally lack trunk stability or core strength use this position. This position increases their base of support and they don’t have to worry about their balance. The problem is that their pelvis is locked in one position making it difficult to rotate their trunk while playing and reaching for toys. Some kids who consistently sit like this may have low muscle tone and they may be delayed with creeping or progression to walking. This position can affect the hip and knee ligaments and bone structure. It may cause tightness in the hip joints with poor alignment of the legs with walking sometimes causing a toeing in gait pattern.
Parents can be instructed in how to help their child weight shift and transition shifting their hips to one side into side sitting and see if the child can then bring their legs forward from that position. Long sitting (with knees partially extended), long sitting with one knee bent out to the side, right or left side sitting, ring/tailor sitting, and short sitting on a small bench or chair are better alternatives for sitting to be able then to work on postural strength for reaching, trunk rotation, and working on balance reactions to catch themselves.
There are a plethora of exercises and activities a PT may use to strengthen postural muscles in sitting, standing, kneeling, prone, quadruped, and using various play items to engage a child depending on their age and motor skill level.
Some activity ideas:
Sitting on large ball and bouncing with control or marching in place
Prone over large ball with weight bearing forward onto hands and reaching to work on puzzle or activity. Superman lifts while on the ball or lying in prone on the floor.
lying on back and rolling into a ball bringing knees to chest and lifting head up while holding position for 10 seconds
Quadruped with reaching and lifting arms above shoulder level
Tall kneeling with hips straight or half kneeling with one foot forward tossing and catching a ball.
bridges, animal walks-crab and bear walking
Wheelbarrow walking
Sit-ups on wedge with feet held.
Child lying supine and lifting legs overhead to reach for a ball held out to squeezed between ankles and lower down to the floor
Any activity involving squatting to pick up items on the floor, adding trunk rotation with squatting
**For further reading, one of my favorite books on child development is “Why Motor Skills Matter” by Tara Losquadro Liddle, M.P.T.
