There is one simple activity that is beneficial for most of us to do every day regardless of age or ability. That is lying in a prone position, or enjoying a little tummy time. Many of us spend hours of the day sitting, whether in a desk chair or wheelchair. This leads to shortening of certain muscle groups, particularly the hip flexor muscles in front of the hip and the knee flexor muscles behind the thigh. In a person with abnormal muscle tone, this effect may be even more pronounced. Reversing the forward curve restores the body to a more balanced position, complementing a standing program and improving overall body alignment.
Hip Flexion Contractures
In children with cerebral palsy, muscular dystrophy, spinal muscular atrophy, and other diagnoses, prolonged positioning with the hips flexed results in a tendency for the hips to remain flexed, even when lying or in a standing position. For some individuals who use standers, this can lead to back pain, as the pelvis is pulled into an anterior tilt position by the tight muscles in front of the hips and the low back is forced into an exaggerated lordosis or sway back. Prone positioning complements a standing program by using gravity to bring the thighs, hips, and belly down into relaxed alignment on the support surface. If tightness is already present and the buttocks remain up in the air with space between the hips and support surface, a towel roll or pillow can be used to provide support, with the goal of gradually decreasing the height of the extra support.
A good book makes tummy time more enjoyable!
Hip Dysplasia
When the hip is flexed and adducted (bent forward and squeezed toward midline), the head of the femur (thigh bone) is more likely to place pressure on the back portion of the hip joint capsule. Over time the capsule loses stability to hold the joint in place, and hip displacement may occur. This is particularly problematic in individuals with spasticity, as flexion combined with adduction tends to be a common combination. Lying face down places the hip in a more neutral or slightly extended position, placing the head of the femur securely in the joint socket. This is particularly important for younger individuals, because bones and joints form based on the forces placed upon them. If growing bodies are regularly positioned in good alignment, they are more likely to maintain that good alignment through life.
Disc Problems
The discs between our vertebrae (the small bones that make up the spine) are like jelly donuts. There is goo in the center of each one that helps cushion the spine as we bend and move. With repeated bending, reaching, and slouching forward, that jelly can be forced toward the back of the body, and can begin pushing on and irritating the nerves that run behind the spinal column. When in a prone position, gravity and the position of the vertebrae gently moves that goo back toward the center of the disc where it belongs.
Scoliosis
Many individuals with abnormal tone are at increased risk for developing scoliosis. Lying with the chest, belly, and hips flat on a support surface can decrease the amount of spinal rotation that may be present. Working to lift the head or use the arms while prone can also help strengthen weak back muscles.
Posture
Reading, using a computer, and watching television are all normal daily tasks that are also conducive to slouching. Over time the ligaments in front of the spine become tighter, and those in back of the spine become looser, so that a person truly can lose the ability to achieve upright postural alignment. This is particularly problematic for those who are already at risk for developing osteoporosis. Lying prone encourages extension of the upper back and neck, helps open the chest, and reverses the C-shaped curve of a sloucher’s spine.
Respiratory Capacity
Many individuals with limited mobility also experience limited respiratory function. Prone positioning facilitates drainage of secretions from the lower lobes of the lungs. It can also help to stretch the intercostal muscles, or the small multi-layered muscles between the ribs, allowing for greater movement of the ribcage when breathing, which allows circulation of a greater volume of air.
So remember, if you want to stand taller, it may just help to look at things from a different angle. Please consult your physician or therapist before starting an exercise program or modifying your existing activities.
Do you feel that spending time in a prone position has helped your child stand taller?
