Balance is the ability to remain steady on one’s feet without a significant reliance on postural strategies or external support. Postural strategies, also called balance strategies; include ankle, hip, reaching, stepping, and knee movements that adjust and counteract for disruptions in the body’s center of mass. Reliance on external support is defined as needing to grab, brace, and/or hold against a sturdy object (bar, wall, therapist, etc.) to prevent a further loss of balance or fall. Large disruptions to balance or ineffective balance strategies will lead to accidents including slips, trips, and falls. Physical and Occupational Therapists specialize in identifying and treating balance disorders. This post will outline 3 key types of balance exercises that all therapists should consider when prescribing standing balance exercises.
Type 1: Static Balance. Static balance is standing in one place without moving the feet, e.g., no stepping. Static balance exercises help improve steadiness in activities of daily living (ADLs) including washing dishes, preparing meals, and getting dressed, to name a few. Variables for static balance exercises include the following: exercise surface (hard floor, foam, rocker board, etc.), stance (wide, narrow, split, single-leg, etc.), and motion (head/neck or arms). Additional considerations include challenging vision (eyes open, obscured, or closed), using an overhead harness, and adding dual-task processing. Changing the variables involved in static standing has a dramatic effect on the degree of difficulty for the exercise. Because there are so many variables with balance training, there is a wide range of opportunities to continually challenge patients and improve their balance.
Type 2: Static Balance + Weight Shifting. Adding trunk movements to static balance exercises is known as weight shifting. Weight shifting is movement of the body’s center of mass from one foot to the other, without moving the feet. Weight shifting typically occurs in the same direction as the movement of the body. For example, if a patient is in a wide stance (feet apart) and moves their torso from left to right, a lateral weight shift to the right will result. In a split stance (one foot forward and one foot back), moving the body forward will results in an anterior weight shift. Lastly, rotation of the trunk results in weight shifting toward the side of rotation, or an ipsilateral weight shift. Weight shifting is common in ADLs such as reaching to the back of a shelf, twisting to look over the shoulder, or stooping to pick something up off the floor. By adding weight shifts, patients are increasingly challenged, and, ultimately, steadiness in standing is improved.
Type 3: Dynamic Balance. Standing and moving about, stepping from place to place, is the definition of dynamic balance. Examples of dynamic balance exercises include walking in parallel bars, stair climbing, and stepping over obstacles, to name a few. Variables for dynamic balance include: surface (hard, soft, thresholds/transitions, etc.), direction (forward, back, side, etc.), and added challenges (step around obstacles, carry objects, head turns/tilts, curbs, ramps, stairs, etc.). Additional considerations for dynamic standing exercises include adding reactions such as throw and catch, start and stop, simulated slip/trip (with harness only), and/or nudges. Similar to static exercises, manipulating the variables for dynamic balance will greatly impact the level of difficulty. Because we live in a dynamic world, challenging patients with dynamic balance exercises is a must for a safe return to the “real world.”
Consider adding all three types of balance exercises (static, static + weight shifting, and dynamic) for well-rounded balance treatments. As with all aspects of care, monitor the patient’s response to exercise and make adjustments, as needed, to progressively challenge and improve standing balance.
Shane Haas presents nationally on topics of balance training and fall prevention. He is the inventor of the ADL Balance Trainer (patent pending) and Balance Games. He treats patients at Trust Point hospital, an inpatient rehabilitation hospital in Lubbock, TX.