Finding Balance — The Critical Importance of Postural Control in Children.

Author, Shelley Mannell for Everyday Heroes Kids

Many parents instinctively know when a child is having difficulty with balance. But it turns out that understanding and treating balance control is fairly complicated stuff. There’s a bunch of literature written about it and naturally all of that research doesn’t agree. However I’ve been a self-described postural control nerd for my entire PT career (in fact it’s one of my two favorite hashtags) so I’ve developed a bit of a feel for the subject.

Postural control is the fancy term for balance. It begins to develop in the womb and reaches maturity during our teen years. We used to think of its development as a hierarchy — one stage after another, you couldn’t get to the next step until you had totally mastered the previous one. We now know that’s not true. In the last 25 years we’ve come to understand that development is really based on a bunch of systems that interact with each other. At any given moment, our body characteristics (range of motion, height, strength etc) combine with information from all of our sensory systems as well as our memories of successful and failed attempts. From all of this data, our brain develops a motor command that is modified along the way until it reaches the muscles to produce balance adjustments, which support the task that we are doing. This is an important concept: any functional skill — from sitting, to writing to walking, to dressing to throwing a ball — all of these are built on a strong foundation of balance. If our balance isn’t great, our functional skills won’t be great either. And often one of the first things we notice when a child is having difficulty with balance is that they don’t look very stable. Core stability is crucial for effective postural control.

As a baby, our postural control is minimal and the stability we have is through that tucked position called “physiological flexion”. What this means is that when we are born some of our soft tissue is a bit tight, which affords us some stability against gravity. We gradually work out this tightness as our systems mature and our brain learns to create stability to support movement.

Unfortunately many of my clients had less physiological flexion when they were born — high tone, low tone, hypermobility, prematurity — all of these can impact the amount of flexion.

One of the ways a baby can compensate for this lack of external stability is to find more internal stability by holding their breath. As it turns out the major muscle for breathing, the respiratory diaphragm, is also a major muscle for postural control. Breath holding helps with stability in the short term but interferes with the development of balance in the long term.

Here are 6 quick facts to know about core stability:

1. Core stability is not created by muscle strength. New research over the past 20 years has taught us that core stability is not equal to the strength of stomach or back or hip muscles. Because we now understand that core stability has as much to do with the brain as it has to do with the muscles, we no longer think of it as a strength issue.
2. Core stability is a more complicated than we thought. This same research has taught us that core stability has to do with groups of muscles (that’s the muscle part) and the order in which they work (that’s the brain part). Sometimes which muscles turn on depends on the direction we are moving but sometimes it doesn’t — this is where things get a little complicated. Fortunately, because we have a new understanding of how core stability works, we also have a new way to help children develop it.
3. Core stability works from the inside out. There are inner core muscles and outer core muscles. The deep, inner core team works the same way each and every time, and it creates a stable center before we move. This preparation of a stable center is a very important piece of coordinated movement. The activity of the outer core muscles depends on this stable center.
4. Many children with sensory and motor challenges have difficulty with the creation of stability before they move. Again, research tells us that children with different sensory and motor challenges (CP, ASD, DCD, Sensory Processing Disorder, low tone) have difficulty creating a stable center before they move. Old-style core strength/core exercise programs don’t work on this. Our new understanding explains why I’ve never seen activities like crunches or wheelbarrows truly help children improve their core stability and why it doesn’t carry over to functional skills like sitting in a chair, writing or running.
5. One of the most important core muscles is the breathing diaphragm. The breathing diaphragm is a super important core muscle. If a child is completing any movement while they are holding their breath, they are not developing active core stability. And using breath holding for stability only works for a short period. Think about a child who can run only as long as they are holding their breath; when they need to breathe, they have to stop running.
6. Core stability is powerful. When we think about core stability we typically think about how balance helps gross motor skills. However, core stability also supports fine motor skills, emotional regulation, sensory processing, functional visual skills, coordination of movement, oral motor and motor speech skills.

SHELLEY MANNELL

Physiotherapist/Owner — www.heartspacept.com

Shelley Mannell is a Physical Therapist with over 30 years experience serving babies, children and adolescents across a spectrum of neurological and developmental disabilities. Shelley is certified in both Neuro-Developmental Treatment and Sensory Integration. She is also the co-creator of Dynamic Core for Kids, an evidence-based approach to central stability for children with motor and sensory challenges.

Everyday Heroes Kids connects families to all pediatric professionals in health, mental health and education with the goal of saving time, money and stress and encouraging earlier intervention for better outcomes in kids. www.ehkidshealth.com