Alignment Matters

I’ve just finished another recreational rowing season and have been reflecting on how much we improved this year, thanks to some great coaching.  One of the first and most important lessons we learned had to do with alignment; we needed to learn to level the boat for stability!  If we couldn’t level the boat, then all our attempts at improving our timing, teamwork and power didn’t make a significant difference to our output.   That’s much like what happens in postural control.  We need neutral alignment of the pelvis and rib cage in order to set up the central stability system of the anticipatory core team (see Taking A Detour on the Road to Oz, Mapping A Route to Oz  and Dynamic Core for Kids for earlier blog discussions of alignment).  There is also discussion of alignment and postural control in children in the research literature.

We now understand that children with Cerebral Palsy experience a different order of recruitment of postural muscles (1).  We also understand that recruitment order is impacted by alignment (2) and that alignment impacts postural stability and motor output (3). Research is now beginning to recommend that we train anticipatory postural adjustments in alignment (4).

There is also beginning to be a body of research on postural control in children with Autism Spectrum Disorder.  The literature indicates that children with ASD exhibit atypical posture at the head and trunk (5) and also have decreased anticipatory postural adjustments (6).

Finally, literature regarding postural control in children with Developmental Coordination Disorder is being published .  These children have less efficient anticipatory postural adjustments in relation to upper extremity unloading (7) and their timing of postural muscle recruitment is also altered in connection with gross motor tasks (8). My clinical experience  reveals that they have difficulty with neutral rib cage and pelvic alignment.

We’re documenting evidence for the fact that alignment matters when training balance in children with motor and sensory challenges.  I suggest we take a tip from my rowing coach and make alignment a focus in our intervention, because central stability appears to be essential for successful and efficient postural control output in our clients.


For the full online course addressing assessment and treatment of central stability in children with challenges, check out  Dynamic Core for Kids here.



 1. van der Heide JC,  Hadders-Algra M. Postural muscle dyscoordination in children with cerebral palsy. Neural Plast. 2005; 12(2-3): 197-203.

2. Burtner PA, Woollacott MH, Qualls C. Stance balance control with orthoses in a group of children with spastic cerebral palsy. Dev Med Child Neurol. 1999; 41: 748-57.

3. Cherng RJ, Lin HC, Ju YH, Ho CS.  Effect of seat surface inclination on postural stability and forward reaching efficiency in children with spastic cerebral palsy.  Res Dev Disabil. 2009; 30(6): 1420-27.

4. Girolami GL, Shiratori T, Aruin AS.  Anticipatory postural adjustments in children with hemiplegia and diplegia.  J Electromyogr Kinesiol. 2011; 21: 988-97.

5.  Molloy CA, Dietrich KN, Bhattacharya A. Postural stability in children with autism spectrum disorder.  J Autism Dev Disord. 2003; 33(6): 643 – 652.

6.  Bhat A, Landa RJ, Galloway JC.  Current perspectives on motor function in infants, children and adults with ASD.  Phys Ther. 2011; 91(7): 1116-28.

7. Geuze RH.  Postural control in developmental coordination disorder.  Neural Plast 2006; 12(2/3): 183-96.

8. Kane K, Barden J. Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder. Hum Mov Sci. 2012; 31(3): 707-20.



2 thoughts on “Alignment Matters

  1. Using the medek intervention has taught me how to develop anticipatory postural control in young kids with movement disorders. We have to learn to take our hands off and provide distal and minimal support because most kids lean into any supporting surface.

    • I agree many children lean in to the support surface for central stability. However, there are many factors that influence their ability to use anticipatory postural control. Alignment is one major factor and we need to consider this very carefully in treatment when we are participating in the clinical decision making process about where to support a child during movement. In my clinical experience, if we provide distal support without properly first setting up the inner core muscle unit, then we are not supporting anticipatory postural control but strengthening inefficient compensations through reactive postural control.