Why is it so hard to get trunk control?

Updated: May 4

In this post, we will describe the relation between the different body parts while sitting with support.

First, let's revise some anatomical references.

Using this image of a normal sitting position, we learn where the ribcage, the iliac crest, sacrum and sitting bone are:

These three pictures illustrate very well how the posture is affected when the fascial system collapses after a brain injury:

Picture "A" shows a healthy boy in sitting. The red lines represent the lower part of the ribcage (top) and the iliac crest (bottom). When the fascial system is in good shape, there is enough space between this two landmarks, usually, we can fit 2 or 3 fingers in between. The child sits on his sitting bones.

Picture "B" belongs to a moderately affected boy who has spastic diplegia. The space between the ribs and the pelvis is smaller, due to the collapse of the fascial system. The pelvis is tilted backward and he is sitting more on the coccyx.

Picture "C" corresponds to a boy severely affected with spastic quadriplegia. Here the collapse is even larger, and the ribcage overlaps the pelvic crest. He sits on the sacrum as the pelvis is tilted backward.

You can test this in your own child. In sitting, just check how many fingers you can place between the ribs and the pelvis.

Trying to achieve trunk control when the structures are not in the right place is always a challenge. The child could learn how to use his muscles to sit up, but eventually, the muscles will fatigue and the position will be lost. The strategy WeFlow follows is the strengthening of the fascial system, targeting the space that is collapse so it can give more support to the structure.

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