Get a Handle on W-Sitting Early

W-sitting can be a typical play and transitioning position, but it becomes a red flag when it’s a child’s main preferred position for play or only play position. 

What is W-sitting?  

A sitting position in which both knees are in front of the body and both feet are behind the body, creating a “W” with legs.

Potential causes for W-sitting:  

• Hip hypermobility – excessive range of motion at the hip joint 
• Poor core strength 
• Femoral anteversion (inward rotation of hips) – structural abnormality of the hip joint

Reasons for concern: 

• Lack of use of core musculature (trunk extensors, abdominals) leads to increased weakness
• Excessive posterior pelvic tilt leads to poor sitting and standing posture 
• Increased time spent in femoral anteversion, which increases risk of developing hip dysplasia 
• Increased hip internal rotation, decreased hip external rotation, and decreased gluteus medius muscle strength can lead to in-toeing gait pattern
• Lack of trunk rotation allowed in W-sitting decreases opportunities for midline crossing affecting development of bilateral coordination skills 

Intervention is key to minimize gross motor delays, promote optimal alignment of the legs and feet, and decrease risk for stress on joints and/or development of back and hip pain. 

Treatment ideas

These positions can be used during all types of therapy (speech therapy, occupational therapy and physical therapy and at home during play, movies, etc.) and each have specific benefits to consider.

Side-sitting: BENEFITS: keeps core engaged, protects hip joints, great transitional position into quadruped or standing.

Criss-cross sitting: BENEFITS: keeps core engaged, protects hip joints.

Long-sitting: BENEFITS: passive hamstrings stretching, keeps core engaged.

Sitting on peanut ball and shifting weight forward & back, side to side: BENEFITS: challenges core stability, improves trunk strength, minimizes stress on hips and knees.

Squatting with focus on knees moving directly over toes and feet facing forward: BENEFITS: activates quadriceps and hamstrings, challenges ankle mobility, preparation for mature gait pattern.

Tall and half-kneeling: BENEFITS: develops core strength and stability, weight bearing through proximal lower extremities, precursor for functional transfers.

Examples of verbal cues to say to adjust sitting position:

“Fix or move your feet”          

“Sit with feet in front”

“Switch your legs”      

“Let’s sit criss-cross applesauce”

The above recommendations can help you get a handle on W-sitting and should be considered when dealing with this situation.

Alison received her Doctorate of Physical Therapy (DPT) at the University of Nebraska Medical Center. She specializes in Pediatric Physical Therapy and has extensive experience with orthopedic conditions, developmental delays, Torticollis and other infant and childhood milestones. Being a mother brings a compassionate insight into her therapeutic approach. She works closely with our multidisciplinary team (speech, OT and PT) to assess and treat pediatric patients in our Tempe Clinic.