Balance and Fall Prevention Part III - How to Train for Improved Balance
By David Drinks
Welcome back for Part III of this series on Balance and Fall Prevention! If you haven’t had a chance yet, take some time to look at the first two parts in this series, so you don’t miss out on any of the info:
Now that we’re all up to date, let’s jump into Part III!
This week, we’re going to begin to discuss how you can improve your balance through training and exercise.
Last week, I laid the groundwork for this discussion by highlighting the systems that are involved in maintaining balance in the human body, and the risk factors for falling that can be affected by proper training.
Based on the systems in your body involved in balance, and an understanding of the risk factors that put you more at risk for a fall, we can now set up a comprehensive balance and fall prevention program.
You see, the ineffectiveness of most approaches to balance training is the lack of a comprehensive approach. Instead, the focus is simply on doing hard things that challenge your balance (e.g., standing on one leg, balancing on an unstable surface like a BOSU ball, etc.).
Often, the person attempting these balancing acrobatic feats is not even ready to approach the exercise that they are trying to do. So, the first step in a comprehensive balance training program is to stop trying to do hard things that make you wobble and flail your arms all over the place and start with something you are ready for.
In fact, when it comes to training your neuromuscular system and your brain for better balance, the goal of any exercise you do should be to have success about 70% of the time and fail only 30% of the time.
That means that if you are trying to balance on one leg on a BOSU ball and you can’t hold yourself for more than a couple of seconds before needing to grab onto something, you are not having enough success with that exercise to make it a good option right now in your training.
So, our first principle is to Build on Success.
While there is nothing wrong with challenging yourself with exercises that make it hard to balance, there is a difference between testing your balance and training your balance.
Finding the correct level at which to start with balance exercise is the first key. From that point, you can build on success and progress to bigger challenges.
However, remember that your success rate for a balance exercise should be about 70% of the time, not 100% of the time. The flip side of trying to do things that are too hard is never progressing to the next level of challenge.
If you have been doing the same balance exercise for weeks, months, or years, and you are 100% successful with it, then you are not progressively challenging your system to gain better balance.
Finding that sweet spot between too hard and too easy is the first key to efficiently and effectively developing balance.
The other problem with simply trying to do hard things in your balance training is that it is not a comprehensive approach. It does not factor in all of the systems for balance and the risk factors for falling that we discussed last week.
To develop a comprehensive balance program, we need to reverse engineer the problem by taking a look at all of the risk factors for falling and all of the systems in the body that affect your balance.
Once you factor in all those things, only then can you develop a comprehensive approach to balance training.
Training the Visual, Vestibular, and Proprioceptive Systems
As I overviewed last week, we have three systems that allow us to maintain balance and control over our bodies.
We use the visual system to process visual input and translate that into motor output to maintain balance and move around without falling.
We use the vestibular system (the inner ear) to process information about head positioning as we move to maintain equilibrium.
We use the somatosensory (body sensing) system to process proprioceptive information (information about one’s body movement and positioning). This system allows us to perceive where we are in space as we move, to feel our body’s movements, and to interpret that input into appropriate motor output to control movement.
All three of these systems send feedback, which is compiled by your central nervous system and integrated to create an overall perception of body position, movement, and acceleration.
While all three of these systems are crucial to your balance, the one that we have the most impact on from an exercise perspective is the proprioceptive system.
An eye doctor is the one to go to if you have vision problems. A physical therapist, doctor, or other healthcare professional can help correct an impaired vestibular system through specialized techniques. However, the gym is the place to go to work on your proprioception through progressive challenges to your neuromuscular system!
Often, we most effectively challenge your proprioception by taking away (or minimizing) how much you can rely on your visual or vestibular system for balance.
Incorporating some balance challenges that remove your visual system (e.g., closing your eyes), or some challenges to your vestibular system (e.g., turning your head in different directions while balancing) will force you to rely on your proprioceptive system to sense where you are and react to maintain your balance.
Here are a couple of examples of how we can do this:
½ Kneeling Set-up with Head Turns:
Balance Beam Walking:
In each of the above examples, you could remove the visual system even further by closing your eyes. However, simply keeping your eyes up when walking on the balance beam instead of looking down will take away your visual system enough to challenge your proprioceptive system.
It is this type of progressive challenge to proprioception that we should focus on first with balance and stability training. Find ways to challenge your ability to feel your body movements and reactively stabilize.
Often, people end up losing their balance and falling when their vision or vestibular sense is challenged or removed in regular life (e.g., it’s dark so you can’t see, or you turn your head quickly and get out of sorts). It is in these moments when your ability to perceive your body movements and react accordingly by proper proprioceptive input and motor output is most crucial.
Start from the Ground and Work Your Way Up
Another thing that is sorely lacking in many people’s balance training programs is going back to the basics. What I mean by this is getting back on the ground and working on balance from the ground up as you did when you were first learning how to move around in early childhood.
Engaging with the ground on that more fundamental level, and challenging your stability on varying bases of support, is a great way to start your balance training.
For one, doing this allows you to provide some more movement variability to your balance training. Simply training balance in an upright standing position doesn’t account for all the movements you do in real life, and thus all the ways your balance is challenged during everyday life activities.
Secondly, taking your feet and lower legs out of the equation by kneeling forces you to engage the more proximal muscles of the hips and core rather than relying on the feet as a crutch.
Many times, people simply give themselves a crutch as they widen their base of support by standing with their feet further apart or turning their toes out as they stand to increase their balance. This is one strategy to maintain balance, but it is not the most effective way to challenge yourself to improve your balance.
Instead, narrowing your base of support on your hands and knees and taking your feet out of the equation is a great way to increase your baseline ability to balance and stabilize.
Performing various balance challenges in kneeling positions before working your way up to standing is another key to balance training. The ½ Kneeling Head Turns above are one great option, but here are some others:
Bird Dog - Clocks:
Bird Dog - Sweep the Floor:
Bird Dog Squares:
Tall-Kneeling Pallof Press & Raise:
Tall-Kneeling Kettlebell Halo:
1/2 Kneeling Kettlebell Halo:
All of the above are just some examples. There are countless ways to challenge your balance and stability in kneeling positions like these. The important thing is learning to challenge your central stability and body awareness at a more fundamental level before we move up to doing it on our feet.
We are not done with balance training yet (far from it!), but we’ll stop there for now. Next week, I’ll talk about how proper functional strength, power, endurance, and mobility training is the next step to better balance.
To start your comprehensive approach to balance training, keep these things in mind:
Start with the right exercise progression – you should have approximately 70% success and 30% failure when training your neuromuscular system to better stabilize and balance.
Focus on ways to progressively challenge your proprioceptive system by performing exercises that take away or minimize the reliance on your visual and vestibular systems for balance.
Start from the ground up. It is not always best to start your balance training on your feet. Instead, take away the feet by moving to the ground to better engage the core. This allows you to challenge your balance from the ground up.
Stay tuned for more to come on your comprehensive balance program next week!
Want to learn more about training your body to Move Better, Feel Better, and Live Better? Our exercise programs at The Med Gym are custom-made to get you exactly what you need.
Our expert coaches will assess your fitness and balance, and design an exercise routine specific to your goals. We can help you get on the right track with your movement and fitness!
Contact us here to talk about how we can help you develop an exercise routine that improves your balance and so much more!