Use it or lose it – balance

Balance is a beautiful combination of different systems in the body. Balance is not just about one tissue or one system in the body.  And it is one of the best ‘use it or lose it’ examples.  I’ll let Lisa Vernon explain:

If you boil it down to a wordy, nerdy, textbook explanation:

Balance is an individual’s ability to keep their centre of gravity balanced within their base of support.

If your centre of gravity falls outside of your base of support, you fall over.

Simple.

We achieve this through a combination of the inputs from visual, proprioceptive and vestibular systems.  

The processing is done throughout the brain, followed by a (lightening quick) decision as to the best good response.

Some of the work is more basic and done at a spinal cord level without brain involvement.

Proprioception refers to the sense of automatically knowing your body position.  

The information is created from joints, muscles and tendons by a variety of types of sensors (receptors, like little reporters).  

This information travels by way of nerve impulse to the central nervous system (brain and spinal cord) and provide information about joint position, motion, vibration and pressure.

The vestibular system is made up of the semicircular canals of the inner ear, the vestibulocochlear nerve that conveys the information, and the parts of the brain that process the information.  

This provides information about movement and acceleration of the head and in which direction.

The visual system is all about…well…vision.  

Close your eyes and your balance is affected.  Walk in the dark and your balance isn’t so good.  Vision is a big contributor to your balance, apart from the fact that it allows you to see potential obstacles and changes in terrain.

If any of these systems are affected, our sense of balance can be affected.  

This can be from:

– injury to a joint (spraining your ankle affects proprioception due to the injury to the ligament(s)),

– reduce your vision and balance is affected, but also puts you at more risk of tripping and falling,

– having a neck problem, especially upper cervical (upper part of the neck) where there is such a rich supply of position sensors

– having an inner ear problem on one side or both sides (eg benign paroxysmal positional vertigo (BPPV) or Menière’s disease to name two)

– something involving the central nervous system eg stroke involving any number of brain areas, but commonly the cerebellum

The good news is that in the vast majority of the time, you can improve your balance.

We can improve our balance by ensuring we maintain our flexibility, improve our muscle strength and practice balance-specific exercises.

Lee & Park (2013) investigated whether lower limb strengthening exercises leads to improved balance in the elderly. After a 12 week program involving 3×12 leg curls (hamstrings) and leg extensions (quadriceps) the lower limb strength and balance of the individuals in the training group had significantly improved compared to their baseline.

Which balance-specific exercises should you do?

Here are some suggestions on ways to practice your balance at home. If you are not steady on your feet, perhaps do them by the bench in your kitchen, and with a chair behind just in case.

Aim to balance in one of these position for 30 sec without falling before you progress.

Stancechallenge
Feet aparton ground
Strideon pillow
Tandemeyes open
Feet togethereyes closed
stand on one legturn head- left/right
turn head up/down

How do we measure balance or falls risk?

Physiotherapists and other health professionals often use the Timed UP and Go (TUG) test as a reliable method to assess mobility, balance, walking ability, and fall risk in elderly persons.

The basis of the test is to measure time in seconds for a person to rise from sitting from a standard arm chair, walk 3 meters, turn walk back to the chair, and sit down (American College of Rheumatology 2016).

What should you do if you notice that your balance has worsened, or someone close to you, or you just want to prevent yourself having any problems?

I would suggest making an appointment with a physio to discuss your concerns and to have your balance assessed.  Physios are well placed to look at your balance as a whole, they can assess the contribution that your strength might have on your balance and test your ability with a variety of challenges to see how you measure up.

If a vestibular problem is suspected, a referral to an ENT specialist or a physio that specialises in vestibular diagnosis may be warranted.

If your neck is contributing to the problem through altered information from a upper neck complaint, that can be treated.

An exercise programme can be devised that is tailored to your ability and safely applied and progressed as you improve.

If you would like to talk about any concerns regarding your balance, ring 8356 1000 and speak with one of our friendly physios.

They would be happy to discuss your situation and whether it would be worthwhile having your problem assessed further by a physio.

References:

American College of Rheumatology 2016, Timed Up and Go Test, TheAmerican College of Rheumatology, viewed 24 November 2016, <http://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Timed-Up-Go-TUG>.

Lee, I & Park, S 2013, ‘Balance Improvement by Strength Training for the Elderly’, Journal Physical Therapy Science, vol. 25, no. 12, pp. 1591-93, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885846/pdf/jpts-25-1591.pdf).

University of Nebraska Medical Center 2009, Timed Up and Go (TUG) Test, The University of Nebraska Medical Center, viewed 24 November 2016

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About the author

Russell Mackenzie
Russell Mackenzie
Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed as a signal of his dedication and passion for headache and migraine treatment. Russell is an avid learner and is engrossed in the best practices of digital marketing to spread the word about health-related topics and improving health literacy in the community.
Russell Mackenzie

Russell Mackenzie

Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed as a signal of his dedication and passion for headache and migraine treatment. Russell is an avid learner and is engrossed in the best practices of digital marketing to spread the word about health-related topics and improving health literacy in the community.
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