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Postural Stability. This word you keep saying, I do not think it means what you think it means.



"Sit down! Stop squirming! Where are you going? Get off me! Keep walking! Slow down! Get off the floor!" Do any of these sound familiar? How about when they hang all over you while standing in line? Or they run full speed down the sidewalk but when it's time to walk they fall into a kid heap on the ground? They can run 60 miles an hour but get tired standing still. They can't sit in a chair for 5 minutes but can jump on a trampoline for 2 hours. They are the movers, the shakers, the leap before lookers. These kids fascinate me. But what in Sam Hill is going on here?


There are many reasons why a kid might not stop moving. She could be sensory seeking. Her vestibular system might be wired a little different or she processes proprioception differently so she seeks input to let her know where body is in space. She could be overstimulated or under-stimulated and is trying to regulate her self. She just might be processing input differently and is responding to it by moving. There are many reasons why sensory input and sensory processing might play in a roll into a kids behavior and I will talk about this all day because I nerd out with sensory stuff but I want to point our lens at another possible reason today.


When I see a kid move at 100 MPH then have to stop and keep a standing posture for more than 10 seconds and start to come unglued then I think Mr. Wiggle'sworth is possibly dealing with something else. The inability to keep posture. Postural instability. The opposite of having postural stability. I'm not talking about balancing books on our heads and sitting up straight at tea time. This is good posture (My dad would make me bring the food to my mouth in a parallel line to the table) but that is only a small piece of the puzzle. In the large picture postural stability is the ability to keep your body in a sustained homeostatic position against gravity without support in order to complete tasks. Like a guitar string. Not too tight, not too loose. Right in the middle so the note can be played and not sound awful. This includes sitting, crawling, standing, walking, or running. Pretty much a static position or ambulatory activity sustained long enough to complete a task without changing activities or losing ones marbles. Essentially anything other than vegging on the couch watching Netflix (Which even this requires some postural stability).


Having posture is important. It's the first step to achieving sustained attention to any one thing. Let's take sitting at a desk. I need a strong core to keep my trunk somewhat straight to keep me alert. If I lie back, my trunk caves in and roll my shoulders and this makes my alert level go down. If I'm too forward I stress the muscles in my back and neck. This can create tension and make me anxious or stressed and tired. My neck needs to be able to support my head to keep my eyes at a level position. If my neck flexes my eyes go down. I need to control my trunk without supports as not to lean too far to one side and slip out of the chair. I need stable joints in my shoulder provide a strong base for which to operate my fine motor for things like writing. Think of a tree. The trunk must be strong enough to support the tree but flexible enough to bend in the wind. The spot where the branch connects to the tree must be strong in order to grow smaller branches, twigs, and eventually leaves. And it must sit tall enough and face the correct position to get the suns rays to continue to live and grow (That is a sweet metaphor by the way).


So I think of postural stability broken down in 4 ways. The first one is core engagement. Our core is made up of all the little muscles that run all along the spine and pelvic floor and some of the larger ones that create our support and initiate our large movements from our spinal engine. Think of my sweet tree metaphor. If a tree has a weak core, the tree won't last too long. Our core is what allows us to sustain static postures for a long time. It's the first part of the plant that grows and is very much what everything on the human body grows around. A strong core is the foundation of good fluid movement and the ability to sustain attentive posture (I don't think "attentive posture" is a phrase yet but I'm making it one because it makes sense in this context and it sounds awesome).


The second is head and neck control. The head houses the vestibular system. This is the balance center of the brain and is responsible for SO MUCH STUFF that I will save for a later blog. But this system plays off of gravity. The head must be held level with the plane of earth in order for us to navigate life without freaking out every time we turn our head (I usually use coffee to help me with this in the morning). So having control of your neck to support your head is kind of a big deal. This also plays into our alert level. A flexed neck with our chin down over a long period of time reduces our alert level, has affects on our mood, and even self confidence. It's a real downer. As well, extending the neck too much also pulls back our shoulders and causes tension. We all know that shoulder tension sucks. We don't want it. And we especially we don't want our kids to have too much tension because tense kids make tense parents (and visa versa). Also, this increases alert levels which is something someone with high tension and anxiety might not want either. Also think of our eyes. Not only does the head control where our eyes go to some extent but our eye muscles must be stable. If we have trouble focusing or tracking then paying attention to something is ridiculously more difficult. So trouble controlling the neck and eyes can play a role into difficulty with attention.


Trunk control. This is the ability to control our torso movements. This is important because the tree that sways in the wind must return to it's natural position. We must be able to control our trunks to rotate effectively, bend forward, reach upward, complete whole body diagonal patterns. Kids that have difficulty with trunk control have difficulty shifting weight when walking, climbing, crawling, reaching, pulling, pushing, even breathing rhythmically. Think how many times you do these things in the course of one day.


And joint stability. The muscles and connective tissue around our joints must be stable enough to support weight, move fluidly, and control distal movements. Proximal stability equals distal mobility.


Ok, having postural stability is important. What can we do about it? Well first is recognizing it. Here are some signs that could indicate a difficulty with posture. W sitting. This is when you kiddo sits on the floor on their shins and their legs splay out to the side. When sitting on the floor or in a chair their torsos and shoulders roll forward. Have difficulty standing for a long time or doing slow movements like walking for long distances. When you run, you don't necessarily engage your core and rely on momentum and other muscles to move you so moving fast is easier than moving slow. When they have knees and hands on the floor like a table top (quadruped) and they sit on their feet opposed to weight bearing on their arms. They don't crawl as much as scoot both knees at the same time. Or just sitting in a chair or unsupported on the floor for a long time in general is difficult. Do they get up out of their seat often, move constantly when standing or sitting, prefer to lean on stuff? These are all some indicators to keep an eye on. Because your child may show some of these signs does not necessarily mean they struggle with postural stability but it is something to be aware of and perhaps a piece of the puzzle if you are struggling with some of these consistent behaviors.


Now that we know what it looks like what can I do at home to help with this? So getting kids involved in sports and activities is a good way to go. Specific sports that I feel focus on overall core, neck, trunk, and joint strengthening the most are things like wrestling, jujitsu, swimming, horseback riding, rock climbing, gymnastics, and even parkour. Anything that involves moving uneven weight, weight bearing, or requires to be on unstable surfaces. I would say any sport or big gross motor movement activity is good and is important for so many reasons and if your kid is involved another sport and they are motivated by it then keep that going! If they're not into sports there are so many cool places these days that have indoor trampolines, indoor inflatable bouncy houses, trapezes, and obstacle courses. Places like Pump it Up or Defy and We Rock the Spectrum are three that are in my town. These places are great for so many other reasons and build general strengthening. Or outdoors are free. Climbing trees, picking up rocks, crawling through mud, hitting sticks against stuff, it's all good! Leaving kids alone outside they innately move in ways that helps with development and strengthens the whole body. But sometimes kids with sensory difficulties have trouble engaging with the world so a little help might be needed.


To help with core here are a few positions to work into games, activities, or even a work out. Get kids on their stomachs and work in that prone position. Pull them on a scooter, on their stomach in a swing, play catch on their bellies. This helps build those extensor muscles needed to keep the torso, neck and head up right. Also holding the opposite position like the fetal position. Keeping the body in full flexion helps engage the muscles on the other side of the spine. Somersaults, barrel rolls, cannon ball rolls, make up a roll! Crawling is another way to work core. Making sure kids have their butts off their feet when the do it. Crawl over couches, under chairs, up the stairs, down the stairs. Throw a bear crawl and crab walk in there as well! And doing all of these activities over unstable surfaces helps kids utilize their core and not overcompensate with their limbs. My own son has extremely strong arms and legs because he uses those more than he should because he has difficulty engaging his core. This is why he flew under my radar because he is so strong when he does things but struggles sitting in a chair and falls to pieces when going on a hike.


To help with trunk rotation, any activity where they intentionally have to rotate their trunk will help with that. Picking up heavy objects off the ground to and put them on a counter on the opposite side of their body. Swinging a bat or club and hitting something. Sitting on a swing to pick up balls to throw at a target. Climbing promotes this movement a lot so climb away!


To promote joint stability any weight bearing activity is good. Push, pull, crawl, climb, jump, etc. If they like hitting the weights with mom or dad then go for it! Pretty much any of the activities listed above but being aware of the joints bearing the weight. For instance a kid who is crawling but scooting on their knees is not really weight bearing on their joints. So cuing them to pick their butts up or switching to another activity. Think yoga!


And to work on neck strength and eye stability working against gravity is a great way to do that. Swings, scooters, slides, hanging the head off a table or bed to work on a puzzle. And if engaging the vestibular system is an issue then one of my favorite activities is Balloon Bop. This is where you take a balloon and hit it in the air with a stick or club. Or even just playing with a balloon. Try throwing a balloon up in the air in front of a kid and watching them not look up. It's impossible. Even for adults! Everyone looks up to follow the balloon and 9.5 times out of 10 they go to hit it! Now we are working on neck strengthening, visual tracking, eye hand coordination and if they are using a stick then we are hitting bilateral coordination! I am getting excited here!


Movement is important for everyone and especially kids for proper development. But sometimes sensory issues or other issues get in the way of that development. Any movement is still great for helping that kid out but being aware that these delays can have an effect on body structure and attention can help you be intentional about the movement you want your kid to get. Being aware of postural instability can also give some insight into some of the behaviors you might be seeing. This alone can allow you to have a bit more patience and give the kid a bit more slack if they are doing something you don't want them to do. Or not doing something you want them to do. They might not be able to help it. And knowing that can help reduce anxiety as to why your kid isn't "listening" to you or their teacher. The way the body moves, the way it is structured, and the way it is coordinated is a large piece of the puzzle and I feel it is often over looked. So if your kid is struggling with attention or "sitting still" and you still don't know why, have a look at how they are moving or even not moving. This might give you some insight into their behavior. It's not the answer to everything but to fully understand something it is best to go back to the beginning. And movement is the root to all we do. A tree is stronger if it grows in the wind. But the wind must blow for it to develop strong roots. Have a look at your kids roots. Are they planted?


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