Recently I have been treating a lot of high school patients with hip and knee pain during sports activities, and in more than one case the underlying cause is probably a long history of “W sitting” which is demonstrated in the above photo. I would always correct my children when they got in this position because I know that it can have some serious long-term risks for their developing bodies like the following:
- It can increase the risks of their hip and leg muscles from getting overly tight or overly stretched depending on what muscles you are talking about. Impairments in muscle length can have broader implications on hip and knee stability, mobility and motor control.
- Increased risk of hip dislocation as the hip is at end-range hip rotation
- Decreases use of trunk and core muscles for stabilization because now the wide base of support is doing it. In addition, this position does not allow rotation of the truck which makes movement and play more difficult.
- It can cause permanent damage to the hip by changing the angle the hip sits in the hip joint. Because of this change, children often exhibit a toe-in pattern with their knees also facing in and potential over-pronation. It can also cause lower-leg tibial torsion meaning the lower leg rotates outward to compensate for the femur (thigh bone) rotating inward. All if this makes for misalignment and difficulties with gait and running.
What to do?
If you do have a toddler or older child that still does this, cue them to get out of the position any time you see it, and ask any care givers or teachers to be aware of it.
Encourage other sitting position like the following:
- long sitting with legs out in front of them
- Tailor sitting or criss-cross leg sitting
- Side sitting
If you continue to notice toe-in pattern as the child ages ask your pediatrician about physical therapy. A therapist can assess your child’s hip alignment, and help create a plan of strengthening and mobility work to encourage a better gait pattern for your child.
Blake Russell, PT