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Postural Control and Core strength is often overlooked in our children. It is very important to remember that everything developmentally starts from the core.

Postural Control: Postural control is a term used to describe the way our central nervous system (CNS) regulates sensory information from other systems in order to produce adequate motor output to maintain a controlled, upright posture. The visual, vestibular, and somatosensory systems are the main sensory systems involved in postural control and balance. Proper postural control is when an individual is able to engage in various static and dynamic activities, such as sitting, standing, kneeling, quadruped, crawling, walking, and running with the ability to contract the appropriate muscles required for a controlled midline posture, as well as the ability to make small adjustments in response to changes in position and movement, without the use of compensatory motions.  (Reference Phsyliopedia)

Core Strength: Core strength comes from the muscle group that control the front part of the belly, also known as the torso. Core strength helps the human body turn, reach, balance, stabilize, sit in a tall posture and use arms and hands for fine motor tasks. (Reference Chicago OT)

Lets imagine for a moment the comparison to a tree trunk; if a tree trunk is weak is sways and bends too much with wind it will break. The trunk of an oak tree is strong, solid and stable therefore the limbs of the trunk can move and bend with great force, but rarely will it break the trunk of a tree. This is the same for our core strength; if we don’t have a stabile and strong core; we try to compensate in a variety of ways.

Here of some of the signs you see with a weak core or poor postural stability:

  • Leans on desk with fine motor task

  • Leans on other people or wall when standing or longer transitions

  • Difficultly lying on stomach for long tasks such as a puzzle

  • Use whole arm or shoulder movements for fine motor tasks

  • Sits in a W-position or C-Spine Position

  • Difficultly with isometric exercise (yoga)

  • Props head on hands

  • Difficultly with balance task

Here is the a simple way to test core strength:

  • Prone Extension: Child lies on their stomach. Then lift arms and legs up straight without bending their knees or elbows.

  • Supine Flexion: Child lies on their back. Then they bend their knees into their chest and cross their arms into an X across their chest. Hold head up as if to touch their knees.



Norms for Prone Extension and Supine Flexion:





Reference:  Marsha B Lefkof. Trunk Flexion in Healthy Children Aged 3 to 7 Years. PHYS THER January 1986 66:39-44

Prone Extension: There were 26 four year olds, 28 six year olds and 30 eight year olds in the study.  They were instructed to lay on their stomach and lift up head, chest, arms and legs off the floor with knees straight and elbows bent.  The standard deviation ranged from 5.67-13.45.



Reference: Harris, N. Duration and Quality of the Prone Extension Position in Four, Six and Eight Year Old Normal Children.  AJOT. January 1981Vol 35 No 1.

PRONE EXTENSION 6-9 YEAR OLDS (BOWMAN & KATZ RESULTS) – 153 right hand dominant participants


Ways to improve Core Strength and Stability:

  • Scooter board: There are so many fun games to play on the scooter board; always encourage your child to lay on their stomach and pull the board forward with their hands not push with their feet.

    • Puzzles: put puzzle pieces on one side of the room and puzzle board on the opposite. Have child scooter board down for one piece and bring it back to place in puzzle.

    • Parquetry blocks

    • Hyperdash

    • Tape mazes

  • Peanut Ball: These can be smaller and easier balls for children to maintain their posture and position on. Encourge your child to sit up tall; not in a C-spine position when playing games on peanut ball.

    • Puzzles: place pieces on one side on ball and board on the other. Encourage them to put one hand on the ground when reaching for puzzle piece and placing onto board for increased weight bearing and postural rotation/control.

    • Pop-up Pirate

    • Letter Charts: maintain balance while reading a letter chart 4-6 feet away

  • Yoga: Isometric exercise are very helpful for the core. Many times when children don’t have a strong core they try to do things are fast as possible. This uses Fast twitch muscle fibers as opposed to slow twitch muscle fibers.

  • Platform or Tree Swings: Encourage your child to lay on their stomach while they they swing. The vestibular input can help improve body awareness and postural control.

  • Laying Over an Ottoman: The iPad for our child can be very reinforcing. For children that are having a hard time maintaining prone extension – have them lay on their stomach over an ottoman with their check off and hands on the floor. Then place the iPad on the floor – they have to use weight bearing and prone extension to watch the iPad.


Postural Control and Core Stability Kit: Click here if you want more ideas and products to use at home.

Prone Extension
Supine Flexion
Norms for Prone Extension and Supine Flexion
Prone Extension Examples
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