Handwriting and Shoulder/Elbow Stability

October 8, 2018

Continuing our handwriting series today, we would like to move to the arm and discuss the role it plays in handwriting.  Did you know that the use of the fingers comes back from the shoulder and that the stability of the shoulder and elbow play a huge role in developing strong handwriting?

Drawing and handwriting involve both strength and motor coordination of shoulder and elbow movements to move the hands across the page and to draw long straight and curved lines.  Children with movement difficulties (low muscle tone, joint hypermobility, DCD, autism) often lack shoulder strength, flexibility and coordination needed for effective control of these shoulder and elbow movements and control needed for drawing and handwriting.

Children with good shoulder control hold the arm close to the body when drawing and writing. The keep their elbow on the table and move with their fingers or wrist. The forearm is aligned more or less parallel to the long axis of the paper. The end of the pencil points in a backwards rather than a sideways direction.

Children who have poor shoulder control for drawing tend to hold the arm away from the body (the shoulder is abducted) with the forearm aligned diagonally across the paper.  The wrist may be bent (flexed) with the end of the pencil pointing sideways. They frequently move from the shoulder for every movement. It is very difficult to use the muscles of the hand when the body, shoulder, and arm that the hand is attached to are moving around or having trouble maintaining their position.

Things to consider-

  • Did your child crawl?
  • Can your child hold his/her arms in the air to play with a toy or play a game?
  • When your child writes does he/she have their elbow on the table?
  • Does your child complain of his/her whole arm being tired with normal daily activites?

An easy way to assess shoulder flexibility and strength follows utilized from skillsforaction.com

A quick test for shoulder flexibility and strength

Instruct your child to hold the arms forwards at shoulder height with the palms facing upwards for 20 slow counts.

Handwriting shoulder strength reach forwards_1.jpg

This task is easy for a child with good shoulder control and flexibility.

Children with poor control will often hunch the shoulders and find it hard work to keep the arms steady for a full 20 seconds.

A test for shoulder flexibility

1  Lift your arms straight forwards and bend your elbows so that your forearms are held vertically.
shoulder flexibility 1.jpg

Stay in this position for 20 seconds.If your shoulder muscles have good strength and flexibility this will be quite easy to do.

2  Now keeping your upper arms horizontal and parallel, twist your arms at the shoulder by moving your hands sideways.
shoulder flexibility 3.jpg    shoulder fleibility 2.jpg

If you have good shoulder flexibility you will be able to position your forearms at 45 degrees to the vertical.

3  Lastly  stretch your arms forwards and bend the elbows so that the upper arms are horizontal and the forearms are vertical.

Next move your arms together so that the elbows and forearms touch each other.

shoulder flexibility 3.jpgshoulder flexibility 4_1.jpg

This movement is easy if you have good flexibility at the shoulder joint and are able to move your humerus away from the scapula.

If this movement is limited, the scapulae are drawn forwards across the chest and you will experience a stretch across the upper back.

Some ideas to improve shoulder stability follow-(from the inspiredtree.com)

Proximal Stability Activities

Because we know that proximal and distal stability are inherently linked to one another, there are ways we can work on building proximal stability to positively impact distal mobility…therefore building function!

1 || Vertical Surfaces

Working on vertical surfaces is a great way to work on proximal stability of the upper extremities.  Those shoulders are working hard as the child writes or draws on an easel, a window, or a pad of paper on the wall.

2 || Tall Kneel

Try doing fine motor activities in a tall kneel position.  This way of sitting gives great proprioceptive input through the knees and hips and causes activation of the core to stay centered.

3 ||Shortening the Chain

Try eliminating pieces of the body chain to focus on one at a time.  For example, have the child use an incline board on a table top surface when writing.  The incline gives support at the wrist and into the forearm which gives the shoulder and core the big job of maintaining stability.

4 || Weightbearing

Weightbearing through the hands provides a major strengthening opportunity for a multitude of the muscles of the hand while also waking up the rest of the arm all the way to the shoulder girdle.  This can be done by having your child lie on her tummy to color, doing yoga poses like downward dog, or wheelbarrow walking!


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