The Balance Bias

There is a bias with balance training and it affects the way we challenge patients. The bias is not negative in any way, rather it helps direct how we implement balance challenges (stance, movement, and/surface changes). The balance bias is described as follows: To bias balance challenges in one plane of motion; add movement, narrow the base of support, and/or limit the surface support in the same plane (this was listed as the 4th Balance Law in the post Haas’s 5 Laws of Balance Training). Balance biases occur in both the sagittal and frontal/coronal planes:

  1. Sagittal Plane Bias: Patient loses balance more in forward (stooping) or backward (reaching/looking up). These patients will benefit from balance challenges that are biased to the sagittal plane. Movements in the sagittal plane include head tilts (up and down), weight shifting forward-back, reaching overhead, hip swivels, etc. Standing with feet together is an example of narrowing the base of support in the sagittal plane. Conversely, standing with a split stance (one foot forward and the other back) is an example of widening the base of support in the sagittal plane, which would make balancing easier. Examples of limiting support in the sagittal plane include standing on foam, hip stick, rocker (with anterior-posterior), inflatable surface, etc. Example exercises for biasing balance in the sagittal plane include: Rocker Board (FB) + Reaching Up, Foam + Reaching Down, Hip Stick + Head Tilts (Up & Down), etc.
  2. Frontal/Coronal Plane Bias: Patient loses balance more to one side or the other, e.g., reaching across midline or leaning to the side. These patients will benefit from balance challenges that are biased to the sagittal plane. Movements in the sagittal plane include head tilts, weight shifting forward-back, reaching overhead, hip swivels, etc. Standing with feet together is an example of narrowing the base of support in the sagittal plane. Conversely, standing with a split stance (one foot forward and the other back) is an example of widening the base of support in the sagittal plane, which would make balancing easier. Examples of limiting support in the sagittal plane include standing on foam, hip stick, rocker (with AP rock), inflatable surface, etc. Example exercises for biasing balance in the frontal/coronal plane: Split Stance + Foam + Head Turns (Left & Right), Tandem Stance + Reaching Across Midline, Rocker Board (SS) + Reaching Across Midline, etc.

Understanding the balance bias isn’t just helpful for aligning balance challenges to better meet patient needs. It is also helpful for progressing balance exercises. For example, if a patient is already in a split stance (bias for frontal/coronal plane balancing), it would be more of a challenge to add head turns (a frontal/coronal plane challenge) than it what it would be to add head tilts (a sagittal plane challenge). In this example, if the patient only needs a small additional challenge to reach a 20:20 balance intensity ratio (see post 20:20 Clarity on Balance Intensity for more information) then add head turns. However, if a larger challenge is needed, add head turns.

I give you permission to be biased toward your patients - as long as it relates to balance training. Use the balance bias to help patients regain stability, confidence, and safety in standing, walking, and accessing their communities.

For more information on biased balance training consider pre-ordering The Haas Balance Book: 100+ Exercises for PT's and OT's. Release date is March 2019 - order now for discounted price and special offers!