Many of my new clients come to me expressing concerns about falling and frequent injuries with statements like:
“I have weak ankles, I need to strengthen them.”
“I should do squats on a Bosu ball. That will help my balance.”
“My balance is fine, I just keep hurting my knee.”
“I twisted my ankle years ago, but it’s OK now.”
Any of these statements sound familiar? Are you plagued by slips and falls, knee injuries, ankle injuries? If so, do you know the best way to improve balance for life, sports and reduction of injury risk? Maybe not. Balance is an often misunderstood physical attribute. Many fitness enthusiasts have old preconceived notions about how to improve their balance. As we approach winter with its perilous ice and snow, I thought it would be a great time to review what balance really is, and how to improve it.
Balance is truly a holistic endeavor. Your ability to balance well depends on multiple systems coordinating at once to confirm your body position in space. Balance is defined as:
A biological system that enables us to know where our bodies are in the environment and to maintain a desired position. Normal balance depends on information from the inner ear, other senses (such as sight and touch) and muscle movement.
Our sense of balance is specifically regulated by a complex interaction between the following parts of the nervous system:
- The inner ears monitor the directions of motion, such as turning or forward-backward, side-to-side, and up-and-down motions.
- The eyes observe where the body is in space (i.e., upside down, right side up, etc.) and also the directions of motion.
- Skin pressure receptors such as those located in the feet and seat sense what part of the body is down and touching the ground.
- Muscle and joint sensory receptors (called proprioceptors) report what parts of the body are moving.
- The central nervous system processes all the bits of information from these four other systems to make coordinated sense out of it all.
Clearly, the central nervous system plays a huge role in our ability to balance. Diseases and injuries which impact vision, hearing, the brain, skin sensations and muscle/tendon receptors greatly impact balance. Diabetes, inner ear diseases and infections, deafness, brain injuries, repeated injuries to muscles and tendons, all affect balance. Making sure that you take appropriate medical action for these kinds of diseases and injuries is step 1, an absolute must and a no brainer.
But, there is another whole therapy for balance that many people do not take into consideration- exercise. There are many exercises which can dramatically improve your balance, as long as you do them. Exercise can improve your balance if it addresses important components of your physical health- your posture, your core strength and stability, your flexibility and your reaction time.
Posture– Your posture plays a big role in proper balance. If you have very abnormal posture- say a forward lean from sitting too much, or a lateral shift due to muscle imbalances or scoliosis- your center of gravity will be shifted, and you are much more likely to fall or trip. For example, rounded shoulders and forward head from sitting too much will impact balance. Your head is meant to sit directly over the spinal column. The spine has several normal front to back curves which allow the vertebrae to stack themselves in alignment. When the head juts forward and shoulders round forward, this forward posture can pitch YOU forward as well. Take a look at your posture. Is it in need of a tune up? Start here. Stretch the areas of your body which are pulling you into improper posture, and strengthen the opposing muscle groups to keep you there.
Core Strength and Stability– Balance is not just a factor of how your feet and ankles address movement. It is really about having a strong, stable core. Your core muscles- all the muscles that attach to the spine- hold your spine in proper alignment and keep your body over its center of gravity (COG). Almost 100% of the people I assess who have poor balance also have weak hips, glutes, anterior core and upper back muscles. If you want to improve balance, work on these areas of the body, not just the ankles.
Flexibility– Poor flexibility is a major contributor to poor balance and eventual injury. Muscles and their attachments are meant to move in many varied directions, to contract, lengthen and stabilize as your body moves through space. For example, ankles which have been repeatedly injured often develop scar tissue, which decreases flexibility and proprioception, and leaves them poorly adapted to surface variation. Another example; the hip flexor muscle group and quadriceps muscle group, which attach the thigh to the hip and the knee to the thigh, are often very tight from sitting. Slip the wrong way and these overly tight muscles pull on the pelvis and cause back pain and injury and tight quads pull on the knee and cause knee injuries. Conversely however, being too flexible without good overall strength is also a major contributor to poor balance, especially in sports. As the saying goes…..“You can’t push a wet noodle uphill”….. meaning that the body moves best and with good balance when it has both strength and flexibility.
Reaction Time/Agility– By this, I mean your body’s ability to contract muscles and lengthen muscles quickly to accommodate fast changes in movement, while maintaining a proper center of gravity. Athletes are constantly moving quickly; side to side, front to back, twisting the upper body or lower body. Without good reaction time, athletes cannot maintain good balance during their sport. Reaction Time/Agility is built on a foundation of strength and flexibility, but you also need to work on making the muscles react to quick movements with agility work. The inability to maintain a proper COG, combined with weakness or inflexibility, is the cause of knee and ankle injuries, both serious and minor.
Agility and fast pace movements are whole body work, not just ankle or feet exercises. Many fitness enthusiasts think that balancing on a wobble board or Bosu ball is all they need to do to help balance. But this is a misconception. I’m not a fan of these techniques. First, both feet are never attached to each other when we move. We do not move like bunny rabbits. Our legs work independently of each other. If you would like to try some unstable surface training to improve reactivity and balance, do so in single leg variations. As an aside, working on Bosu balls or other unstable surfaces does not improve strength more than working on stable surfaces. Don’t let fancy tools distract you from your exercise purpose.
Of course, there are many balance influencers which we can’t improve or change. Black ice is something we can’t see and thus can’t avoid. Accidents happen. Plus, we are all aging. Aging stiffens soft tissue, decreases the activity of our central nervous system and our sensory perceptions. Brain injuries and nervous system diseases can be incapacitating. But, hope springs eternal. Exercise, the right kind of exercise, will make things better, no matter the surface you walk on or the physical issues you can’t control.
Next blog, Part 2 on the subject of balance, I’ll outline some great exercises to work on balance and stability. Stay tuned!