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Improving balance is multi-factorial, it is more than just standing on one leg

10 Sep 2023

How to improve Balance

The functional approach to multisensory balance

I started MolyFit to change people’s attitudes toward ageing and to improve health and wellness in the over 65’s.

The Functional Aging Institute (FAI) looks at four aspects in the balance domain. In this article I will cover the multisensory system and look a little into what is balance?

The number one cause of accidental death in the over 65’s is a fall. This is why balance is important.

When you fall, the first thing you do is put your arms out. As a Functional Aging Specialist (FAS), I would train you to take a step when you lose your balance, instead of reaching with your arms out. This would be achieved by firstly practicing stepping forward using one leg. You would then place your hands onto my shoulders with arms outstretched. Leaning into me with straight arms, I would then ask you to transfer your bodyweight onto my shoulders. Next, when I count to three, I will move out of the way causing you for fall forwards and step forward to stop falling. This would be practiced until you felt confident, then we would repeat, eventually removing the countdown.

This is just one example of how a FAS can train you to reduce falls.

Improving balance is multi-factorial, it is more than just standing on one leg.

According to Rose 2010.  Balance, at its simplest, can be considered to be control of the body’s centre of mass over the base of support and within the limits of stability.

These three core concepts are so important if you want to improve your balance: base of support, centre of gravity control, and limits of stability.

Base of support (BOS)

The BOS are the bits of you that make contact with what you are on!

If you’re standing, it’s your feet, standing with crutches, your hands and feet, and sitting, your bum.

When standing your foot position determines your base of support. To improve balance, think about your BOC. Wide feet will give you a large and stable BOC, whereas feet closer together will give you a small and narrow BOC.

When training someone to improve balance, I will manipulate their BOS by working from larger to smaller using six steps.

• Wide

• Shoulder width

•Feet together (side by side)

• Semi-Tandem

•Tandem

•Single Leg

It is common for older adults to widen their feet to feel safe and stable. To improve balance, practice by manipulating your base of support. One example is a standing arm curl exercise. By putting yourself in a semi-tandem stance position, you are going to potentially challenge your balance to a greater degree than a shoulder-width stance.

Centre of gravity control and limits of stability

Centre of gravity control (COG), also called postural control.

COG is the ability to keep your centre of mass (gravity) within your base of support during either static (feet do not move) or dynamic (feet move or change position) activities.

Your centre of gravity (in most people) is located just below the navel and just inside the abdominal wall. This is why having an effective core is so important. It allows you to control your body easier and maintain balance.

If your COG moves outside your BOS, then you will begin to fall and will need to make quick postural adjustments to regain your balance.

How far you can move your COG without losing balance is called your Limits of Stability (LOS).

Because of various reasons, as you get older, your limits of stability can decrease, but it also can be improved.

Challenge your LOS by leaning or reaching in a narrow standing position. Move as far as possible in all directions to overload the system. An example of this is a forward and backward lean. As you lean forward, feel your heels start to rise off the floor, then lean backwards and feel your toes start to rise off the floor. If you lean too far you will take a step, this will show that you are at your limits of stability.

I would recommend doing this with someone to guide and support you until you are comfortable with the exercise.

Another way to challenge your balance is to hold a dumbbell out to the side using one arm. Have your feet close together and this will shift your COG towards the dumbbell, making your body adjust the muscles that control posture. Keep the base of support small. If the feet are in a wide stance your centre of gravity control will not be challenged because your BOS is large.

Multisensory

The three systems that work together for balance are visual, vestibular and somatosensory.

To train one of these systems you need to dampen the others.

Somatosensory

When standing, the sense of touch will be on your feet, sitting, your bum. To train the somatosensory system, dampen your visual input by wearing sunglasses, turning down the lights or closing your eyes. A lot of people lose balance when closing their eyes because they are too dependent on their vision. This can create a problem in winter when it gets darker and is harder to see, also summer when wearing sunglasses.

Sit and/or stand on a hard surface to maximize somatosensory input. Performing standing exercises in socks or bare feet will enhance somatosensory input even further.

Visual

Reduce somatosensory input by sitting and/or standing on something soft.

Focus on a single point to improve gaze stability.

Work on visual focus by looking from one object to another quickly (start with eye movement only and then combine head and eye movement). Track an object as it moves through the visual field (start with eye movement only and then combine head and eye movement).

Vestibular

The more you dampen visual and somatosensory input the greater you will rely on the vestibular system.

Adding dynamic movement such as reaching or walking under these conditions will require even greater vestibular control.

A separate method to promote the vestibular system is to move your head from side to side. This can easily cause dizziness and even nausea in some so should be done in stages with a therapist.

I would start sitting, turning the head to the side, back to centre, then to the other side. Imagine a clock face, when turning to the left, turn to about 10:00 on the clock, and to the right, 2:00 on the clock. If this feels okay and doesn’t cause a reaction, then I would repeat with eyes closed. I would then progress the exercises accordingly dependant on reaction. 

Another method I would use is called Walking with Head Turns. Here, you walk a straight line while moving your head from left to right in rhythm with each step. When you step forward with your left foot your head (and vision) should turn to the left to about 10:00 on the clock. When you step forward with your right foot your head (and vision) should turn to about 2:00 on the clock. You should be able to walk forward smoothly and quickly without deviating from their straight line.

N.B. All information is current at the time of writing this article, source material from the Functional Aging Institute https://functionalaginginstitute.com/

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