The W-Sitting Controversy: Evidence and Science



Beverly Cusick begins this program with an explanation of the controversy over the issue of W-sitting and the related state of evidence to support both sides of the issue. Bringing the sciences of full-term neonatal posture and bone geometry to the discussion, she relates the typical hip neonatal and knee joint alignments to typical strategies used to acquire the ring-sitting position.

Beverly will then discuss the pathomechanics and pathokinesiology inherent in habitual and prolonged W-Sitting with legs and feet in lateral rotation, i.e. W-Sit-LR. She will discuss the physiologic adaptation of soft tissues, bones, and joints to routine use, and the condition known as “miserable malalignment syndrome.”

The presentation targets children with potential orthopedic issues and ligament laxity although the principles pertain to children with cerebral palsy.

Beverly concludes with an extensive list of ideas for researchers.

Course plan:

Module 1: Biomechanical Contributions to Early Sitting Acquisition

Module 2: Biomechanical Factors in W-Sitting and its Acquisition

Module 3: Physiologic Adaptation of Muscle & Fascia Applied To W-Sitting-LR

Module 4: Physiologic Adaptation of Bones & Joints Applied to W-Sitting-LR

Module 5: Should We Discourage or Ignore W-Sitting-LR?

Module 6: Summary

* You can view the course online whenever you want, there is no deadline for completion.

* Within a maximum of 24 business hours following your purchase (8:00 a.m. to 5:00 p.m., Monday to Friday), you will receive all the necessary information by email to view the course.


  1. Explain the biomechanical benefit that typical full-term newborn alignment of the leg and foot brings to the independent acquisition of the ring-sitting position.
  2. Name three of the hip muscles used by typical infants to drive and decelerate the transitions between ring-sitting and quadruped positions.
  3. Compare the triplane alignment of the femoral head and neck axis (HNA) in ring sitting and in W-sitting positions.
  4. Discuss the influence of W-sitting-LR on the incidence of lateral weight shifts of the torso in play.
  5. Describe the rotary forces applied to the femur during transitions between W-Sitting-LR and kneel-standing positions.
  6. Discuss the status of evidence regarding the contributions of habitual W-Sit-LR to musculoskeletal problems after childhood.
  7. Describe the condition of the long bones and knee joints in “miserable malalignment syndrome.”
  8. Explain the science that associates habitual, prolonged W-sitting-LR with miserable malalignment syndrome.
  9. Distinguish between common advice and kinesiologically healthy alternatives to W-Sitting.

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