Article written by: Jim Storhok DPT, ATC
Autumn is in the air, and it is the time of the year when leaves start to fall and the ground can become slick at times. For this month’s newsletter, I wanted to discuss the importance of balance training to decrease the risk of falls as we moved into the fall and winter months. There are things that we can do that can decrease the risk of falls. As a physical therapist, I hear patient histories which include recurrent ankle sprains as well as frequent falls. It is very possible that the patient could be rehabilitated in regards to improve strength, range of motion, and overall function, however if the person’s balance is not specifically trained, there could be an increased risk for recurrent problems. Balance training is an important part of a well developed exercise program. If a person’s position sense, which is a joints ability to know where it is in space, is trained properly they should be better equipped to avoid injury and have improved longer-term function.
It is a common mistake from a patient’s perspective to think that when they are performing balance training exercises that they should be extremely steady. I hear at all the time that patients feel that they aren’t doing well with an exercise if they are having difficulty maintaining balance either in a tandem stance which is one foot directly in front of the other in a heel-toe position or on 1 foot. I always say that “if you’re not wiggling, you’re not working,” which means that if you are making adjustments at the foot and ankle to maintain midline when balancing, you are doing well with the exercise. We are always trying to keep patients on the boarder-line of failure, which means if they are “too good” at a balance exercise, then we will try to make the activity more difficult to challenge the position sense more. That is the reason why we may put you on an uneven surface to balance, or we may put you on only one foot as opposed to two feet. Those adjustments make the exercise more challenging to the position sense system. It’s kind of like adding weight to a strength training exercise. We don’t add weight, but we may add balance time, we may take away one sense, such as the sense of sight by having patients close their eyes while balancing, or we may add difficulty by having them do something with their upper body during the exercise to throw off the center of mass. This makes the system work harder and improves overall balance.
Activities that we typically put patients through may include single leg stance or tandem (heel-toe)balancing on an Air Ex uneven surface, balancing on a trampoline, playing catch by throwing a ball off of a rebounder while balancing on the Air Ex pad, etc. These types of activities not only challenge a person’s position sense, but it also strengthens the patient’s lower leg muscles which help to give the leg more dynamic stability during functional tasks.
If you don’t have a balance component to your exercise program, consult with your family physical therapist. This is an easy addition which will make your program more well rounded, and can reduce the occurrence of future potential injury.