W sitting research

Hi All,

Early on this year I had a mum in clinic who was very afraid of what W sitting would do to her little girl, from all she had read in the media (all types of media) however she was also from a scientific background and asked me what the research was (she was looking at back/hip pain and wanted to know prognosis).
I have been looking through the research and have found a little bit but I was hoping that some of you, you wonderful experienced therapists all over the world, may know of more.

I am looking at the research as this mum prompted me to check my facts and my biases (the kids I see in clinic are NOT the typical classroom) and I’m sick of the N1 statements “my child w sat and they are fine v mine w sat and now XYZ is terrible”
This is in relation to neurotypical kids not Connective Tissue Disorders like EDS, Marfans (note Hypermobility itself is not a connective tissue disorder, it can be a sign of one, but isn’t a disorder/diagnosis itself) CP, Down syndrome etc

So if you have research/know of research (reviews, clinical trials etc) that supports

  • causative of pain in future (hip, knee, back etc)
    -bilateral coordination issues
    -fine motor issues
    -gait concerns such as in toeing

Here is what I have found so far:
1.W-sitting does not effect or change the shape of the hip bone. (Rerucha et al 2017, Frye 2017, Lincoln 2003, Staheli 2001)
2.W-sitting does not cause developmental hip dysplasia (DDH) (Goldstein et al 2019)
3…W-sitting does not appear to cause degenerative joint disease or arthritis (Rerucha et al 2017, Lincoln 2003, Staheli 2001, Ryan 2001)
4.W-sitting does not appear to cause in-toeing (Sielatycki et al 2016, Altinel et al 2007)

I have read the article in relation to flat feet - it was suggesting an association not causation…most likely the children with flat feet also have increased hip internal rotation and / or anteversion. (They are hypermobile…)

Which has me wondering,
A) is W sitting really the problem or is it just a sign for us to screen further (ie there will be some kids with a weak core but I wonder if just strengthening the core without prompting position change, would that result in the child adopting a different sitting posture… and save a lot of nagging/fear?)
B) sitting all day in any position is not good for any child or adult

Thank you in advance for your time! :hugs:

I have not done a thorough research search. For me I see it as indicative of something else. Generally a weak core but I also check hip torsion/version. I also work on side sitting and transitions not just in the AP plane because they aren’t using their core as much. So to me it’s more about what w-sitting can mean and how it can limit them. Does that make sense? And I love that you have some research. I think more should and could be done but like most things there isn’t a lot.

It totally makes sense. Thank you!
This is how I like to approach it. There’s not much we can do about the anteversion/torsion but it’s worth monitoring to make sure it’s improving with age like it should.
I am just wondering if maybe shifting the focus off W sitting and onto movement in general might be more helpful and strengths based (just thinking similar to the recent adult literature around there not being a perfect posture and posture itself didn’t cause pain it was the lack of movement/prolonged postures)
This mum was also a bit stressed about the fine motor/bilateral coordination implications for kindergarten… which I found absolutely nothing on… OT friends?

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Not being an OT I am probably not looking in the right place (sigh)

I think it makes sense. I wonder if there is any research about core strength and w-sitting. Or if you could look at their core strength and find research on that and fine motor/bilateral coordination? I think it all impacts each other. Maybe work on core strength and teaching new movement patterns like you said rather than focus on the w-sitting. Hopefully it will all impact each other? I’d love to hear if you find more!

@Nicole Hey there! I found this article and although you have to request the full text, the abstract seems interesting


Also, even if we aren’t seeing resulting orthopedic issues, there is a question as to why this the child’s preferred sitting position. I agree with @Starfishtherapies, is core strength and postural endurance an issue? As far as bilateral coordination and crossing midline is concerned, functionally, being in that w- sit does seem to limit the dynamic movement at the trunk. Altough this isn’t a research article, this blog post from the Inspired Treehouse is good, too! @Nicole, thank you so much for this question! :slight_smile:

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Thanks for joining the discussion @tots-mary :slight_smile:
Ill check out that article tonight, thanks for helping collate the research.

I am not quite sure about that blog article’s reference to anteversion… Anteversion is normal. Average adults have 10-15degrees of anteversion in their hips… its completely normal for hips to be anteverted and actually hip and back pain are associated with retroverted hips. Baby’s have about 40degrees of anteversion, the unwinding process occurs from 0-8years. I think the 10% figure is referring to is excess anteversion (2SD above mean) but this blog reads that anteversion is bad and is a medical condition.
But thats why preschoolers can so easily W sit - is because the structure of their bones allows this…but as they get older and the femoral neck “unwinds” they cant W sit anymore… but these might not be the ones we are seeing in clinic (but remember our population is bias)

Some more research I have come across:
Altinel et al 2007 found that of 1134 children aged 3-6 years, 64% preferred to sit in the W-sit position. However, only 6% had”in-toeing” gait (3/4 of these being both legs in-toe)

Leblebici et al 2019 found significant Femoral Anteversion (that is more than 2 standard deviations above the mean for their age) can be associated with (not cause) more frequent falling and more tiredness with walking long distances

Dont get me wrong - I think for a certain bunch of kids that W sit its a sign there is something else going on… (and usually thats why they come to see us) but there are a whole lot of “normal” kids that W sit that never make it to clinic.