During my studies in physiotherapy in the 1970s, I was deeply influenced by a lecture given by an orthopedic surgeon. He shared a remarkable story from the 1950s when he was an intern participating in a study on a remote Caribbean island inhabited by an indigenous tribe. The purpose of the study was to investigate why all the newborns on the island had club feet, while none of the toddlers exhibited the same condition. The key to this phenomenon turned out to be the grandmothers. Upon closer observation, the researchers noticed that the grandmothers spent their days massaging the babies’ feet under the coconut trees. By the time the babies were ready to walk, their feet appeared normal, and they could move properly.
Years later, when I began exploring fascia in my work, I realized the importance of addressing fascial restrictions as early as possible. The earlier we focus on these restrictions, the easier it becomes to facilitate movement and correct improper movement patterns. Toddlers often develop habits that parents find endearing but can lead to numerous problems and chronic injuries later in life.
Toddlers sitting in the frog or W position
In this position, the child sits on the floor on their bottom, knees bent, and feet turned outwards, resembling the shape of the letter ‘W.’ While there may be a structural issue in the hips causing this position, often children imitate someone or find it comfortable. However, the extreme internal rotation of the hips in this position leads to shortening of the internal hip rotators and over-lengthening and weakening of the external hip rotators, specifically the buttock muscle (Gluteus Maximus). This pattern becomes noticeable when the child walks or runs, with their knees facing inwards while their feet move outwards. As the child grows older, this often results in hip and/or knee pain due to imbalances in the legs. Furthermore, this position can contribute to the development of bunions, where incorrect hip rotation affects weight-bearing through the ankles, causing the foot to twist for balance.
Walking on the toes
Toddlers walking on their toes are often disregarded by parents as a passing phase. However, this habit also creates imbalances, not only in the ankles and calves but also throughout the entire body.
Babies skipping crawling
Skipping certain stages of development, such as crawling, can indicate imbalances that hinder movement. To flex the hip and bend the knee, a baby needs the ability to rotate the upper body in both directions. If it becomes uncomfortable on one side, the baby will skip the stage and compensate by shifting on the floor while in a seated position.
But how do babies develop these imbalances?
To answer this question, we must consider the role of fascia and the autonomic nervous system. The autonomic nervous system activates when we perceive danger or threats, and while the mind may be aware of 20% of these situations, the body perceives the remaining 80%. When the body senses overload, it treats it as a threat. If the fight or flight response is not an option, freezing occurs, and the fascia or connective tissue contracts, locks, or stiffens around the affected area to provide support. Prolonged restriction of movement due to this fascial response results in imbalances. For example, if the fascia protects the internal hip rotators in a shortened position, causing the external rotators to remain in a lengthened position, it directly affects muscle function and posture. If not addressed early in life, this imbalance becomes a more significant problem when the individual adopts compensatory movements to function.
Can braces or taping help babies or children in these cases?
Movement is the key to resolving these issues. The sooner we restore movement in restricted areas, the faster we see results. Bracing or taping affected areas to support weaker muscles or encourage new habits may provide temporary relief, but it’s essential to note that these measures essentially act as compensatory “locks,” introducing new areas of fascial restriction to achieve a sense of balance. Alternatively, the focus should be on identifying areas of restriction and facilitating movement, reassuring the autonomic nervous system that movement is safe and that continuous fascial support is unnecessary. By reminding the brain of the original neutral neural pathway, we can restore normal functional movement patterns.
Should children wear supportive shoes?
Absolutely not. The foot consists of numerous small bones and joints designed to move in various ways. The more we engage in diverse foot movements, the stronger and more resilient they become against injuries. Additionally, the foot serves as the body’s keyboard. When the surface that we stand on changes, it results in a change in pressure on specific areas underneath the foot. The change in pressure is analysed by the proprioceptors in the ankle which then send messages to the brain to activate the rest of the body to maintain or restore balance. When foot movement is restricted, the brain receives less information, impeding the body’s ability to respond adequately. As young children, we develop these skills and strengthen the relevant receptors by walking barefoot. Children who wear shoes, especially inflexible ones, exhibit less body control compared to those who grow up barefoot or with flexible shoes. Shoes with added stability, such as arch supports, are even worse for the same reason. When a foot is supported by a shoe, the muscles in the foot become lazy and less responsive. This effect is magnified when, as adults, our feet need to support a larger and heavier body.
How can babies experience fascial restrictions?
There is increasing evidence that even mild forms of maternal stress or anxiety during pregnancy can affect the fetus and potentially have long-term consequences for infant and child development. During the last trimester, a large fetus may become “stuck” in a specific position in the womb, causing any part of its body to remain immobilized. For example, if one hip becomes stuck in internal rotation, it can lead to fascial restrictions that become evident when the mother tries to change the baby’s diaper and encounters resistance in rotating the hip outwards.
In some African cultures, small babies are carried on their mother’s back for extended periods with both hips in extreme external rotation and abduction. The lack of movement in this position can cause fascial restrictions, leading to reduced hip mobility and dysfunctional movement patterns.
In other cultures, babies are tightly wrapped in blankets, preventing any movement, which can result in diminished muscle function and flexibility.
The key to a functional body is movement.
The only way to restore mobility is by facilitating movement and convincing the autonomic nervous system that it’s safe to move. Muscles can only function properly when movement and balance are restored. If muscles are misaligned, preventing full range of motion, they can only be strengthened within the limited available range. If you can rotate your hip inwards fully but not outwards, it indicates disabled and dysfunctional external hip rotators. A hip surrounded by dysfunctional muscles lacks support and relies on compensation patterns for movement. This misalignment eventually damages the hip joint itself.
How do we restore normal movement in babies and young children?
Before we can restore movement, it’s crucial to conduct a comprehensive assessment to identify the areas where fascial restrictions are impeding movement. All movements involve the entire body, so it’s important to assess not only the apparent area but also the rest of the body. When working with babies or toddlers, this assessment can be done quickly and in a playful manner.
Once we determine the limitations, we use gentle strokes combined with facilitated active movement to restore neural pathways. Essentially, we persuade the brain that the danger or overload has passed and that it’s safe to move in those areas. This process is conducted swiftly and playfully. Babies and children respond quickly to these techniques since they generally have fewer layers of compensation patterns. At this stage, their brains are highly receptive to learning and exploring new movement possibilities.
Install new habits
It’s vital to continually remind the child, as well as the parent or caregiver, to avoid reverting to old habits and instead help establish new functional habits. Parents may need to change some of their own habits to encourage movement and enable their children to develop strong bodies.