This study investigates the relationship between different toilet sitting styles (squat vs. western) and their effects on ankle range of motion (ROM), constipation symptoms, and lower limb strength in school-going children aged 6-12 years. With increasing urbanization, the shift from traditional squat toilets to sitting toilets may influence children's musculoskeletal development and bowel health. Squatting involves greater ankle dorsiflexion and muscle activation, which may contribute to better lower limb strength and improved bowel function compared to sitting postures.
A comparative cross-sectional design will be used, including participants from public and private schools. Data on toilet usage habits will be collected along with demographic information. Ankle ROM will be measured using a goniometer, lower limb strength will be assessed through the 1-minute sit-to-stand test and standing long jump, and constipation symptoms will be evaluated using the PAC-SYM questionnaire. Data analysis will be conducted using SPSS version 26. Ethical approval will be obtained from the Research Ethics Committee of Riphah International University, Lahore.
Students age group: 6-12 year.
Both male and female groups
Normal developing children
Children who have been using either sitting or squatting toilet type .
Children with lower limb surgery
Children with acute or chronic disease like irritable bowel syndrome
Children using both toilet postures
Children with neurological or developmental delays affecting toilet independence like Cerebral Palsy and autism.
The study population will consist of school-going children aged 6 to 12 years enrolled in selected public schools. Both boys and girls will be included. Participants will be grouped based on their habitual toilet usage (squat toilet users and western-style sitting toilet users).Only children who are healthy, ambulatory, and able to perform physical tests will be included. Children with neurological conditions, musculoskeletal deformities, recent lower limb injuries, congenital abnormalities, or known gastrointestinal disorders (other than functional constipation) will be excluded. Informed consent will be obtained from parents or guardians, along with assent from the children before participation.
Other
Cross-sectional
Not listed
Goniometer
A goniometer is a reliable tool used to measure ankle range of motion (ROM), including dorsiflexion and plantarflexion. The axis is placed at the lateral malleolus, with arms aligned along the fibula and fifth metatarsal. Assessment is done in a seated or supine position\*\* with the knee flexed or extended.
1 Minute Sit-to-Stand Test
1-minute Sit-to-Stand Test (1-MSTST) is a simple and reliable test to assess lower limb strength and endurance in children. The participant sits on a standard chair with arms crossed and performs maximum sit-to-stand repetitions in 60 seconds. Each full stand and return to sitting is counted as one repetition. The total number of repetitions is recorded, showing \*\*high reliability in pediatric populations.
Standing Long Jump
The Standing Long Jump (SLJ), also known as the standing broad jump, is a field test used to evaluate explosive lower-limb power in children and adolescents. Participants start with both feet together just behind a marked line, execute a countermovement by flexing the knees and hips, swing their arms, and leap forward as far as possible, landing on both feet without falling backward. The distance from the take-off line to the back of the heel nearest the line is measured in centimeters. No shoes or minimal footwear are allowed to ensure consistency .Each participant performs two trials, and the longest valid jump is recorded as their score .Research including large pediatric samples confirms that the SLJ test exhibits excellent test-retest reliability.
Patient Assessment of Constipation Symptoms (PAC-SYM) Questionnaire
The PAC-SYM (Patient Assessment of Constipation Symptoms) is a validated questionnaire used to assess constipation severity over the past two weeks. It includes 12 items covering abdominal, stool, and rectal symptoms, rated on a 5-point Likert scale (0-4). Scores indicate severity ranging from minimal to very severe symptoms.
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