Balance is one of our essential biomotor abilities. 'Bio' (life) and 'motor' (movement) abilities under-lie all functional motor tasks (Bompa TO. Theory and Methodology of Strength Training. Toronto, Ontario: Kendall/Hunt Pub-lishing, 1983). Our key biomotor abilities are strength, endurance, power, flexibility, agility, coordination and, last but not least, balance.
Balance is an essential ability for athletes if they are to perform well in many sports. Good balance is also key for recreational activities such as cross-country walking and cycling, and playing with kids and grandkids. It is also critical as we get older: falling is a leading cause of death among people aged 65 or older (Hoyert DL et al. Deaths: Final data for 1997. National Vital Statistics Reports, vol 47, no. 19. Hyattsville, MD: National Center for Health Statistics, 1999).
The common perception of how to improve balance is often misleading. Most people don't need to stand on a Swiss ball or wobble board as part of their balance training, unless they are going for extreme sports or the circus. However, many training pro-grammes intended for older adults use fixed-axis machines, where the exercises are often performed seated. This may help with age-related loss of muscle mass and strength, but does almost nothing to help balance. A successful balance-improving training programme has to include movements that closely approximate sporting or daily activities, including those that often result in falls.
Let's divide exercises into two classes: those that activate righting reflexes; and those that activate the tilting class of equilibrium reflexes (Chek P. Movement That Matters. CA: C.H.E.K Institute, 1999; Abreu BC, ed. Physical Disabilities Manual. New York, NY: Raven Press, 1981).
Righting reflexes are activated when you move across a stable surface. A classic example of a righting reflex is when you step off a curb that is lower than expected, and you have to catch yourself to avoid falling. Tilting reflexes are activated when you move across an unstable surface, such as stepping onto the moving walkway at the airport.
When selecting exercises to improve balance, it is important to match the exercise reflex profile to what you will encounter in 'real life'. As life is rarely black and white, many situations and exercises combine both righting and tilting reflexes. Imagine walking up the aisle of an airplane: you are mostly using a righting reflex. But, when the plane hits turbulence, and the floor moves up and down beneath you, your tilting reflexes also need to be activated to stay upright.
Toe Touch Drill
Gait deficiencies and balance issues are most commonly seen while walking as 85 per cent of the gait is spent on one leg.
The most common problem is an inability to resist the inward roll of the foot (pronation), often seen with distention of the abdominal wall, which can affect the rest of the leg. The Toe Touch Drill improves the stabilizer muscles while improving balance and coordination on one leg to help gait and stepping activities.
- First, imagine yourself standing at the centre of the clockface where the hands are usually fixed.
- Stand on one leg in a good upright posture-tall through the spine and head, chest slightly lifted, shoulders relaxed and chin gently drawn in so your head isn't poking forward.
- Draw your belly button in towards the spine just enough to activate the deep abdominal wall muscles.
- Slowly bend the standing leg while reaching out with the toe of the opposite leg in front of you, towards 12 o'clock. Keep the knee of your bending leg directly over your second toe; do not let it wander out of this alignment. When you can no longer keep it in this position, mark the distance that your toe reached and bring the foot back to the centre.
- Repeat the toe reach to all the other number positions on the clockface, marking how far you can reach with your foot. Repeat with the other leg.
- Now, perform the exercise by stop-ping just short of your maximum reach for each position.
- When you've been doing the exercise for two to four weeks, retest yourself to see how much you have improved.
Many people are uncomfortable performing a squat in the gym, yet it is one of our most basic movement patterns in daily life.
- Straddle a narrow bench that is approximately chair height, with one leg on either side of the bench.
- Stand tall with a good upright posture and gently draw your belly button in towards the spine, just enough to activate the deep abdominal wall muscles.
- Bending at the hips, knees and ankles, slowly lower your backside towards the bench. Keep your torso upright, chest lifted and eyes looking straight ahead.
- Before you touch the bench, stand up straight again.
- Repeat as many times as required.
Those who need additional assistance when they start this exercise can hold a cane or stick in one hand to aid their balance. This exercise increases the functional base of support and improves confidence. And, as strength, endurance and confidence build, the stick and, finally, the bench can be removed, as you progress to traditional squats.
For the more advanced athlete looking for a balance challenge, squats can be performed on a variety of unstable surfaces, such as a rocker or wobble board, or a BOSU ball (see www.physicalcompany.co.uk or www. fitter1.com for balance training aids). In all these squats, you are moving over the stable surface (a wobble board tips, but it does so only because you make it tip), so it's predominantly the righting reflex that is being trained.
Supine Lateral Ball Roll
This excellent exercise integrates the upper and lower extremities via the trunk, improves stability, balance and gait, and can help with most pushing or pulling activities. Also, activation of the extensor muscles from the shoulder to contralateral hip helps to strengthen the muscles across the apex of the thoracic curvature, improving posture.
- Lie supine on the ball with your upper back, shoulders and head supported by the ball. Place your feet on the floor, with knees at 90 degrees and hips fully extended until the trunk and thighs are parallel to the floor.
- Extend your arms out parallel to the ground, palms facing up. A wooden dowel rod resting lightly on your hands can assist in cueing.
- Activate the deep abdominal wall muscles by gently drawing the belly button in towards the spine.
- Starting with small movements, shuffle your feet sideways, allowing the ball to roll laterally under-neath you as you keep your hips, shoulders, arms and body parallel to the floor. Be careful not to let your arms or hips drop and twist towards the ground.
- Keep your hips fully extended and your body in a flat table-top position. Your torso should also remain in a straight line from pelvis to chest to head. The head should not lift up, but should stay in the same horizontal plane as the trunk and hips at all times, on or off the ball.
- Repeat the movement to the other side.
- Start with four or five small movements to each side. When you are thoroughly warmed-up, you can make bigger movements.
- Hold the tongue in the physiol-ogical rest position on the roof of the mouth behind the front teeth. To find this position, simply swallow and hold the tongue there. This provides an anchor point for the deep neck flexor muscles as they support the head, and helps to prevent other muscles in the neck from overworking, leading to postural imbalances.
This exercise is primarily for training the righting reflexes, as you are applying force to the ball in order to move it. However, some tilting reflexes are being trained as well, especially if someone else applies a gentle force to the ball during the exercise.
Seated Posture Trainer
Doing this exercise with a soft 5-lb (2.3-kg) weight (like a beanbag) on your head will help to develop a better sense of proprioception (an awareness of movement and spatial orientation) while also learning the proper seated postural alignment. As you become more confident with this exercise, one foot can be raised off the ground, shifting your centre of gravity and increasing the amount of balance you need. With this one exercise posture, balance and confidence are both improved.
- Sit with a good posture on a properly sized Swiss ball so that your thighs are parallel, or slightly above parallel, to the floor.
- Place the soft weight on your head, hold a neutral curve in your lower back and gently draw in your belly button.
- Challenge yourself by lifting one foot off the ground, maintaining good posture and alternating your feet every few seconds.
- You can activate your tilting reflexes by having a partner gently prod the ball from different angles, so that you have to react to stay seated on the ball.
Paul Chek is founder of the C.H.E.K Institute in Encinitas, CA, and an internationally recognized lecturer and educator in the fields of orthopaedic rehabilitation and corrective and performance exercise. For more information, call 0208-874-6942 (UK) or visit his website at www.chekinstitute.com.