If your child has ever worked with me, even if it was only for 1 hour, you have probably heard the word alignment at least 37 times. Achieving and maintaining proper alignment is an integral part of physical therapy and is the basis of all my treatment sessions.
So what is alignment? Alignment refers to how the joints of the body line up in relation to other joints. In the human body the head, shoulders, spine, hips, knees and ankles should all be arranged in line with one another. There is very specific criteria for proper body alignment, but to keep it simple, we want to make sure that the head and trunk remain in an upright position with the head directly on top of the shoulders, the trunk directly over the legs and the hips and knees directly over the feet.
Why is alignment so important? Proper alignment of our joints puts our muscles in the best position for them to work optimally. A muscle can not work up to its full potential, meaning that it can’t be as strong as it should be, if the muscle is too lengthened or too shortened. If a joint is moving through large ranges of motion then the receptors in the muscle (the muscle spindles and Golgi tendon organs) can not provide accurate information to the brain about where the joint/muscle is and how to maintain alignment. A joint that is out of alignment is not conveying the proper message back to the brain which can make activation of muscles more challenging and sensory input inaccurate. If a joint is out of alignment and a muscle is being stretched too far then abnormal forces will be placed on developing bones and can lead to bony deformities. If a child is standing or sitting with poor alignment, then it takes extra work to perform transitions and move through space.
There are many reasons that a child may not be able to achieve good alignment by themselves. Reasons include but are not limited to, children who have high tone (hypertonia) or low tone (hypotonia), children born prematurely, children with weakness or tightness in their muscles, children who have brain injuries, nerve injuries or genetic conditions, etc.
The pictures below demonstrate children that are not in alignment to begin with but with handling corrections and strapping, optimal alignment was able to be achieved.
The pictures below demonstrate children that are not in alignment to begin with but with handling corrections and strapping, optimal alignment was able to be achieved.
When I assess alignment, I am looking at a child from a few vantage points to make sure that their alignment is optimal in all planes. If a child can stand I often start assessing alignment at the feet and work my way up to their neck and head. If a child needs assistance with sitting, I will typically start my assessment by looking at their pelvis. Pelvic alignment is another one of my big soap boxes. Here’s why!
It is so important for the pelvis to be in good alignment. The pelvis is the main base of support when a child is sitting and greatly affects trunk, head and leg positioning when a child is standing. The most common alignment concern I see in my practice is a pelvis that is tilted backwards – this is called a posterior pelvic tilt. When the pelvis is tilted backwards the child must work harder to activate the correct muscles in their trunk to stay upright which often leads to an inability to sit or the child needing to use their arms to keep themselves upright. When a child’s pelvis is not in good alignment it puts the other joints of the body in a poor position which makes movements of the extremities more challenging. A tilted pelvis can make it very difficult for a child to move their legs or to reach with their arms which will make play and functional arm activities difficult. A posterior pelvic tilt also causes compensatory posturing of other joints which can include a rounded spine, forward head and externally rotated hips. This is just one example of poor alignment and the effects it can have on stability and mobility skills.
The gold standard in regards to alignment would be to have a child positioned properly 24 hours per day as they move through various positions. This is obviously a very challenging, nearly impossible goal to achieve but there are various pieces of equipment that can help a child maintain good alignment for long durations of time. Therasuit, superwraps, Chattanooga bands, hip helpers, elbow and knee immobilizers, electrical stimulation, hand splints, and kinesiotape are all devices that I use in my practice to achieve improved alignment during therapy sessions and while children are at home. Theratogs, other compression garments and positioning equipment like activity chairs and standers can also be used to help with maintaining optimal alignment. There are some baby/child positioners on the market that do not allow for optimal alignment – the bumbo seat and the jolly jumper are just 2 of the many examples of equipment that do not optimize pelvic, hip or spinal alignment.
Do you want to learn more about optimal alignment? Do you have any questions about how to help your child achieve optimal alignment? Do you need help finding adaptive equipment, dynamic orthotics or strapping techniques that can assist your child in maintaining their best posture throughout the day? Please comment or reach out to me if you have questions about how to best position your child and devices that may be able to help.
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