HELPFUL ARTICLE

Gross Motor Skills

By Dr. Tony Ebel

“He will always find a way to slouch, no matter what we do.” 

That’s what Joseph’s mom shared with me during his gross motor assessment we were doing when he was first beginning care in our office. And oh man, she sure was right. 

When he sat on the bench, he had to slouch and lean against the wall or against his mother. When he went to stand up, it took an enormous amount of effort, so much so that he really never could stand all the way straight… but just simply ended up slouching while standing. And even when he walked and moved around, he was slouched, crooked, and entirely exhausted. 

Gross Motor Skills | PX Docs

Joseph was 12 years old and presenting to our clinic for help with daily challenges associated with his autism and chronic constipation diagnosis, but the first thing that caught my attention and needed to be addressed were his significant gross motor delays and struggles. 

Because his body was so “wound up + worn out” at the same time, he then sought additional movement stimulation via constant stimming and other behaviors. 

We knew that if we were going to help his daily challenges with sleep, constipation, social anxieties, and communication we had to first vastly improve his gross motor skills… because as this article will explain, they are intricately linked to each of those functions and conditions. 

What Are Gross Motor Skills? 

Gross motor skills are movements that require the entire body, and incorporate large muscle groups such as the arms, legs, core, and the spine. These movements include things like sitting upright, walking, running, jumping, climbing, riding a bike, playing sports, etc. 

Most pediatric practitioners will focus primarily on how the ‘torso’ or ‘core’ is functioning when they assess a child for gross motor development, but we feel strongly that if we think of more as the spine or even ‘neurospinal’ system, it really helps parents + practitioners get a fuller picture of what’s really going on with gross motor skills. 

Simply put, before any movement is initiated in the arms or legs, nerves + muscles within the neurospinal system must activate + coordinate first. This is why the spine and the core are perfectly synomonous for this discussion. 

Since that is where the core and entire central nervous system is located, it’s important to break down the neurospinal system just a bit further as well, into these 3 main parts: 

  1. Cervical (neck) region 
  2. Thoracic (torso) region
  3. Lumbopelvic (core) region 

And perhaps even more important, when sorting out gross motor skills and function, is to talk about the transition zones’ within the neurospinal system, which is where those key regions link up and coordinate together. 

Like all motor functions, whether gross or fine motor skills, coordination is essential. If all the nerves and muscles are not communicating with each other in an efficient, coordinated fashion… things don’t develop and function the way they should. More on this later! 

Why Are Gross Motor Skills Important? 

There are three (3) main reasons why gross motor skills are so important to childhood development and overall health of all kinds. They are: 

  1. Gross motor skills must develop before fine motor skills 
  2. Gross motor development is intricately linked to overall brain development and function 
  3. Gross motor development is also intricately linked to other crucial basic health functions like digestion and immune function 

Delays and challenges with gross motor skills will first show up in activities of daily living for young children by causing them to struggle with everyday functions like just getting dressed, getting in and out bed or the car, navigating their physical environment, and so forth. 

Then later on in life as the gross motor delays negatively affect brain development, they can lead to problems with sitting up and paying attention in school, playing and interacting with other kids, getting involved in sports and other activities, and more. 

And finally, while not discussed as often as they should be in the standard pediatrician or PT/OT world, problems with gross motor skills are absolutely linked to common childhood problems such as chronic ear infections, respiratory infections, and constipation

What are the Gross Motor Skills Developmental Milestones?

Like so many things in pediatric development, the standard charts are not to be taken as an absolute ‘hard line’ cut off for each and every thing listed below, because so many kids have their own developmental journey. But, this list will help you sort out where your child may be with their current gross motor skills and development. 

  • Newborns-2 months: Turns head from both sides while on back, lifts head and able to turn to both sides while on belly, performs tummy time on floor regularly
  • 3-4 months:  raises head in line with trunk when pulled to sit, tolerates tummy time well, rolls from belly to back
  • 5 months: rolls from back to belly, bring feet to mouth laying on back, pivots in a circle while on belly to each side
  • 6-8 months: sits alone, catches self with loss of balance when sitting, crawls on belly
  • 9-11 months: crawls on hands and knees, walks with two hands held, cruises around furniture
  • 11-12 months: walks with one hand held, stands alone for a few seconds
  • 13-14 months: crawls upstairs, walks alone well, stands up from the floor without support
  • 15-18 months: kicks a ball forward, crawls down the stairs (on belly, feet first),  can run even if they fall easily
  • 2 years: walks up and down stairs alone, walks and runs fairly well, jumps in place with both feet off the ground
  • 3 years: balance on one foot for a few seconds, catches a large ball, rides a tricycle
  • 4 years: Run, jump and climb well, is beginning to skip
  • 5 years: climbs well, begins to skate and swim, rides bicycle without training wheels

What Would Struggles With Gross Motor Skills Look Like?

For most children, delays and challenges with gross motor skills are quite readily apparent. Oftentimes the biggest signs are a child that just fatigues extremely easily with even the most basic of physical activities, is always slouched and bent over, and then in time starts to avoid physical activities altogether. 

Even when they are sitting at the table or desk, they will often struggle to sit up and maintain an upright posture. Additionally, when they go to move from one posture to another it takes a lot of time, a lot of effort, and happens in a very disorganized and inefficient manner. 

Addressing Gross Motor Delays

The first place a child with gross motor delays is likely to end up is a PT/OT Therapy Center, where traditionally all the exercises and therapies are designed to activate and strengthen the core. 

But while that is still the focus of most traditional practitioners and therapists, for kids with gross motor skills we frequently find that there is something deeper going on first. And if that first developmental issue is not addressed and taken care of, then their progress and results with PT/OT will be limited and short-lasting. 

The inherent challenge we are talking about here is something that affects the ‘tone’ of the gross motor system first – a condition called subluxation. While not yet a common household term, again and again we find that subluxation is the root issue of so many other gross motor problems. 

Keeping it simple, subluxation has two main parts that are both intricately connected to problems with gross motor function: 

  1. Altered tone + tension (too much + too little) 
  2. Incoordinate + imbalance 

The biggest ‘hidden secret’ to helping kids with gross motor delays is not simply addressing their lack of tone or weak core muscles, but actually first addressing the increased and excessive tone found in their neurospinal system, and specifically the neck and upper torso regions. 

For the most part, only Pediatric Chiropractors are trained to fully analyze and assess tone + tension within the neck and neurospinal system, and that is likely the reason that it’s so overlooked and not taken care of for the vast majority of gross motor development cases. 

This is why so many parents report to us that despite many months or years of therapy, and working on things as much as they can with stretching + strengthening exercises at home, their child still struggles to make progress and often plateau with traditional therapies. When that happens, it’s a sure sign that subluxation of the cervical and thoracic spine is the true root cause of the child’s challenges. 

The science behind all this is really quite simple. If all of that neuromuscular tone + tension is ‘jammed up’ and ‘stuck’ in the upper regions of the neurospinal system, there simply isn’t enough ‘left over’ to then activate the core, the pelvis, and the arms and legs. 

To get an even clearer picture of what’s going on here, let’s look back at Joseph’s case and his EMG (electromyography) Scans below. 

Gross Motor Skills | PX Docs

The markings and notes made on his INSiGHT Scans tell you everything you need to know about why his posture picture above at the start of this article is the way it is – he was both ‘wound up and worn out’ at the same time. His cervical and thoracic regions had excessive tone  + tension, and his neuro-core was weak and exhausted. 

Now take a look at where he was after just one week of getting neurologically-focused, tonal adjustments! 

Gross Motor Skills | PX Docs

He still has a long way to go to get all the way there, but after just one week he’s not only sitting up so much better, but his mother also reported he was craving physical activity for the first time in his life instead of avoiding it! He wanted to go for walks, run on the treadmill, and said he even wanted to lift weights! 

Look Deeper with the INSiGHT Scans

For now thousands and thousands of parents we’ve been able to help find the answers and action steps they were looking for all along to help their child get over and past their gross motor delays! 

It all starts with doing a neurological assessment that looks deeper than traditional pediatrician or therapy assessments, and really focuses entirely on the central nervous system, spine, and subluxation

If the challenges discussed in this article sound like your child, then reach out to one of our PX Docs and get scheduled for your 5-Point Clinical Process and INSiGHT Scans today! 

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