“This is part of our on-going series of exploring neurological conditions that can affect a number of individuals and specifically how Physical Therapy can help”
Today’s topic is Balance:
What is balance? We know that it keeps us from falling and allows us to maintain an upright posture, which seems simple, right? However, the system is complex and it needs to be trained just as much as our cardiovascular and musculoskeletal systems. Many people that I work with are much more apt to say I need to start working out to get my strength back or the Doctor said I need to work on my heart health via a walking program or going to the gym. I often hear that people say oh my balance isn’t good but oh well, it’s life and I am getting old.
I would disagree; your balance is like any system in your body, it can improve and get better with proper training as well it can deteriorate if you don’t use it enough and this typically happens as we age. It is common to have a number of balance impairments if you are faced with a neurological condition such as a Stroke, Parkinson’s, Multiple Sclerosis, spinal cord injury, head trauma and or cerebellar dysfunction. However, it is also common for any person to have difficulty with balance in different situations whether in everyday life or in a sport. This means that anyone can train their balance system to make it operate better and a person can be more functional.
First, a brief review of this system. Balance itself is a complex process of integrating sensory information, having your brain plan and then execute the movement to achieve the ultimate goal of not leaning or falling over in a variety of situations. This planning and integration occurs when just walking, running or more complex tasks like skiing or surfing. This is a very dynamic system comprised of using one’s vision, vestibular and somatosensory systems along to control one’s posture. The other component is the integration of sensory and motor components of the musculoskeletal system and central nervous system (your brain telling your muscles what to do) in order to generate movement in your body.
Somatosensory receptors are located in in your joints, muscles, ligaments and skin to provide information about muscle length, pain, pressure, temperature, muscle contraction and joint position. Visual receptors allow for environmental orientation, object hazards and opportunities presented by the environment. The vestibular system provides the central nervous system with information about the position and motion of one’s head. Your central nervous system interprets this information and then sends signals to your musculoskeletal system (ankle, thigh, trunk and neck muscle areas) to control and generate movement in different positions and on different surface areas that keep someone from falling.
So how can we train this system and how do we test if it isn’t working as well as it should? A simple test is simply standing on one leg with your eyes open. Can you stand still in this position without touching your opposite leg down down on the ground or moving your standing leg? Too easy, try closing your eyes. Having a little more difficulty? Well, we have something we can work on! So now that you closed your eyes, we took away your vision so your vestibular and somatosensory sytems had to work harder and they may be a little weak or it could be a mobility or stability impairment that we have mentioned in earlier posts. Still to easy? Now, try standing on a pillow (uneven surface) on one leg with your eyes closed. Harder? You can do other movements like standing with one foot in front of the other too, testing the same scenarios eyes closed, eyes open and standing on an uneven surface.
Okay, so you have noticed some “wobbly” positions. What I love about balance activities is that you can do them anywhere! For example, stand on one leg while doing the dishes or brushing your teeth. Test yourself, how long can I stand like this, can I close my eyes, can I stand on a pillow, can I turn my head side/side and up/down? As you work on these movements you will begin to notice that you have less sway, are more stable and can hold positions for longer periods of time. You can also use things at the gym like balance discs, bosu balls or stand on one leg while doing bicep curls.
And, there may be some people where standing on one leg seems too hard and not safe. In this case, you can stand with both of your legs on the ground or sit on a stable surface if you are not able to stand. Then you can simply close your eyes, or do reaching patterns (chops/lifts) with or without resistance. You can also have someone gently nudge you and you make your body react so it doesn’t fall over. The use of a yoga ball is great too, just simply sitting on a yoga ball and doing certain exercises can help improve balance and postural reactions.
Balance exercises can be easy or hard and sure to challenge you. Give these a try and see how you fair. Have fun!