A common theme I have noticed with my patients is looking down at the ground. Whether they are performing a shoulder stretch or a balance exercise it seems I am constantly repeating myself, “Don’t look at the ground!” This nasty habit forms and we don’t even realize we are suddenly walking around with our heads down. Why am I so picky about this? This forward flexed posture can actually increase the risk of falling.

One in three people over the age of 65 will fall this year (1). Falling poses a major threat to the mobility and independency of our elderly population. Our balance system is extremely complex. There are many systems which play a role in maintaining balance including our inner ear (vestibular system), receptors in our joints (somatosensory system), eyes (visual system), strength (musculoskeletal system), and our POSTURE. All systems must be in place for optimal balance.

I could go on for hours describing how each system works. However, for the purpose of today’s discussion let’s focus on the effect of posture on balance.

Don’t Look Down!

When I instruct my patients to avoid looking at the ground they exclaim “Then how do I know where I am going?” As we age, the ability to scan the environment ahead of time tends to decrease. Meaning instead of looking in the distance for future balance disturbances we look directly in front of us to make sure nothing is in the path. By simply looking down our center of balance shifts forward up to 16% (2).

As we look downward a cascade of reactions occur down the rest of the body to counteract the shift. Our ankle muscles have to work harder, we flex our hips, and our low back loses its curve. With our upper body already forward, it becomes difficult to take normal steps. I call this the “senior shuffle.” It is characterized by short, shuffling steps in which the foot barely lifts off from the floor.

Are you at risk?

There is a very quick test to perform to see how your balance stacks up. Stand next to your countertop and hold on with one hand. Then, stand on one foot. When you are ready, remove your hand from the counter top. To pass the test you should be able to maintain your balance on one foot for 30 seconds. This simple test shocks a majority of my patients. “When did my balance become so bad?’’, they ask.

Don’t panic. Practice makes perfect. Improving your balance can be as simple as practicing a few simple exercises and correcting your head posture! The key is finding an exercise which is challenging, yet safe. All balance exercises should start with you close to a safe, stable surface (ie. Kitchen countertop), to hold onto if needed.

Let’s start with a tandem balance exercise. Stand with your feet stacked in a line and maintain your balance without holding on for up to 30 seconds. If this is too easy, balance on one foot. If tandem balance is too challenging, hold on with as little support as you safely can (such as one finger). A more functional approach will be marching. Along the counter top alternate lifting your knees high (like you are marching) with nice big steps. Marching will mimic our walking pattern and encourage your upper body to stay upright, improving your posture.

Again, I want to highlight that your balance exercises should make you feel slightly off balance, however you should not be afraid of falling over. Don’t forget to look FORWARD and keep an upright posture! Try these simple balance exercises to improve your safety, mobility, and confidence while walking around the community.

References
1. Tinetti, Mary E., Mark Speechley, and Sandra Ginter. “Risk Factors for Falls among Elderly Persons Living in the Community.” The New England Journal of Medicine 319 (1989): 1701-707. Web.
2.Saha, Devjani, Steven Gard, Stefania Fatone, and Stephen Ondra. “The Effect of Trunk-Flexed Postures on Balance and Metabolic Energy Expenditure During Standing.” Spine 32.15 (2007): 1605-611. Web.