Balance is a key component to any physical therapy evaluation. I cannot tell you how many times I have heard my patients say “I have never had good balance,” as they struggle to stand on one foot during our initial visit. This is especially true for my patients who are “more experienced” (ie. over 65 years of age). As we age, it is normal for our balance to begin to decline.
One in three people over the age of 65 will fall this year (1). With falls being the leading cause of injury-related visits to emergency departments in the United States and the primary cause of accidental deaths in people over the age of 65 years, it is time we do something about this (2). Our balance system is extremely complex. Balance uses three main body systems: our visual system (eyes), somatosensory system (sensation of what surface we are on or where our joints are in space), and vestibular system (inner ear). We also rely on the musculoskeletal system (muscles, joints, and posture) in order to remain upright.
If you are thinking “My balance has always been bad, there is no way to fix it now,” I urge you to read on. Just like any other skill, practice makes perfect! There are countless ways to improve your balance and today we will go over some simple exercises you can do at home to challenge your balance.
Narrowing Base Of Support
When testing your balance, stand close to your counter-top or another sturdy surface. This will allow you to have support if you begin to lose your balance and need to catch yourself. The counter-top is there for safety. When progressing your balance exercise, hold on with as little support as you SAFELY can. Balance exercises should be challenging, yet attainable, and most importantly SAFE.
The first exercise you can try is to stand with your feet as close as possible. You may notice it is more challenging to stand with your feet close together as opposed to spread out. The progression of these exercises work on the principle of varying our base of support. The smaller the base of support (closer our feet are together), the more challenged our balance system is. If you are able to maintain this position for 30 seconds without losing your balance, challenge yourself more by placing your hands across your chest.
The next exercise you can try is called tandem stance. This is when you stand in a heel to toe posture and maintain your balance. If this is too difficult (unable to maintain for at least 30 seconds before losing your balance), you can try what is referred to modified or semi-tandem stance. This is when you stand with one foot in the instep of the other foot.
If you are able to perform tandem balance for thirty seconds, you can try single limb stance. This is when you stand on one foot without hooking your foot behind your stance leg and without holding onto any surface. Keeping your knee unlocked is the key to being successful in this position.
Take Away Your Eyes
Now that you have progressed through narrowing base of support, we can make these exercises a little more functional and challenging. Many falls occur when we get up during the night. When it is dark, our visual system is unable to help us balance. Meaning, we must rely more heavily on our inner ear and somatosensory systems. To replicate this common source of injury, you can practice the postures we just discussed, but with your eyes closed. This is a BIG jump in balance ability. Start with the feet together posture and work your way to single limb stance if you are able.
Another common story I hear is of people falling while simply walking in public and turning their head to see something. Turning your head changes your vision and challenges the inner ear. How can you avoid falling in this matter? Add head turns to the balance exercises we have already covered. While standing with your feet together, in tandem, or on one foot, you can turn your head left and right or up and down. These can be added to any of the previous exercises as a way to make it more difficult.
These are just a few ways to challenge your balance. If you feel you have poor balance or you are fearful of falling, contact any one of our Buffalo Rehab Group offices for a personalized balance assessment!
1. Shumway-Cook A, Baldwin M, Polissar N, Gruber W. Predicting the probability of falls in community dwelling older adults. Physical Therapy. 1997; 77(8): 812-819
2. Fuller G. Falls in the Elderly. Am Fam Physician. 2000 Apr 1;61(7):2159-68, 2173-4