As I go about my job of teaching, I run into many different types of health and fitness professionals. Invariably, many of these professionals discuss their frustrations about the challenge they have with regard to rehabbing their patients in order for them to retain the functional capacity to perform their activities of daily living (ADLs). And, rightly so. Each year there are several new studies that discuss the issue of loss of balance as people age. Indeed, a whole new specialty in the world of fitness and rehab has spawned because of this. Case in point, as I write this, I am on my way to teach a series of Fall Prevention & Balance seminars.
In her book, Older, Faster, Stronger, Margaret Webb writes that, “From as early as age 25, our ability to balance begins to decline; after 65, the peripheral senses, brain signals, and vision functions that keep us balanced and generally upright become so impaired that one in three people will topple over just doing normal activities, like walking with a bag of groceries.” And, while the fear of falling tends to limit the activities some folks will do, actually falling often leads to injury and subsequent disability. It is hard to argue with research evidence that consistently suggest that, as we age, that balance is affected and falls increase. Falls are one of the leading causes of injury death and the most common reasons of nonfatal injuries among the elderly. Fortunately, most causes of falls and instability can be treated successfully, resulting in improved mobility and reduced risk of falls. And, this is where personal trainers come in.
Given that the ability to balance is inherent to moving safely through daily life, everything we do for our clients in terms of exercise programming should be informed by their ability to safely move themselves through space, otherwise known as dynamic balance. I find it ironic that with all of the exercise equipment that has been designed to challenge, and thus improve, balance, I see many still struggle to even basic movements safely. For example, when a client is performing a squat or a lunge, there should be no over-pronation, collapsing of a knee toward the midline, or dropping of one side of the pelvis. If a client has these issues then it is imperative to continue to work on hip, knee, and ankle stability. Generally, I wouldn’t avoid the exercises I’ve mentioned while working to improve stability, but I would limit a client’s range of motion to involve only the motion that they can perform safely and without losing balance.
Backing up a bit, as a part of a fitness evaluation, it is totally appropriate to include a screening or two for balance. A few of these simple assessments include the unilateral stance, the functional reach, and the Berg Balance Scale. Combining these results with the rest of your fitness evaluation will yield information that highlights where you should spend your exercise programming efforts, at least in the short term. A few examples of these exercises include activities that will promote balance and prevent falls; here are a few of the activities I use in the beginning (and then progress as appropriate):
- Single leg balance –standing on one leg, foot and toes gripping the ground, knee not locked, but quadriceps engaged, pelvis should stay level (keeping hands on hips helps).
- Four-way hip exercises (first without resistance band, then with band) –the instructions are basically the same as in #1. However, keep in mind that the leg being challenged is the standing –not the moving- leg. Standing on one leg, move the opposite leg into abduction/adduction, flexion/extension. This creates a challenge for the standing leg –begin with small motions, progress to larger motions only when balance is maintained and pelvis remains stable on the standing leg. When athlete/client is proficient, add a bit of a challenge by using some light exercise tubing for the swinging leg. Begin with small, slow motions, and progress from there.
- Single-leg mini-squat –Consider this an extension of single leg balance. Standing on one leg, have athlete/client squat down, using a very small motion, and return to standing. Progress to a larger range of motions or add light weight to increase the challenge.
- Step-ups/step downs –using a 6”-8” step, slowly step up and down, focusing on keeping the toes pointed straight ahead and keeping the patella in line with the big and second toe. Be sure to watch for the foot collapsing in to excessive pronation, or the knee collapsing medially. Controlling for these two mistakes, will allow the foot, ankle, and hip stabilizers (foot and toe flexors, gactroc/soleus, and gluteus medius/minimus) to have a better biomechanical position from which to work.
Each of these activities will help to strengthen the foot, ankle, and hip stabilizers (foot and toe flexors, gactroc/soleus, and gluteus medius/minimus) will help keep your client to safely perform their ADLs, move through space safely, and gain confidence to possibly be even more active. All of these exercises can be made more challenging as the need arises. Progress from a stable surface to an unstable surface –but only after your client/athlete has mastered the current challenge.