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Balance training

Balance is a complex skill. It depends on the brain receiving and responding to messages from our muscles, joints and eyes.

We know that balance can be improved with practice. Training your muscles and nerves to respond surely and quickly to a threat to balance means you will be better able to protect yourself from falling.

There are two types of balance – when you are standing still (often called static balance) and when you are moving (often called dynamic balance). You need to improve both types of balance to help prevent falls.

LiFE principles of balance training

To improve your balance you have to practise a challenging balance activity. To make balance gains you need to keep progressing to a more challenging level.

The principles of improving your balance are:

• reducing your base of support
• shifting weight and moving to the limits of stability
• stepping over objects.

Reducing your base of support

Your base of support is all the parts of you that are in contact with the floor or something that is holding you up. For example, if you are standing and holding onto a table, your hands and feet are your base of support. As you reduce your base of support, you increase the difficulty of balancing. For example, standing with your feet apart is 14standing with a wide base of support; standing with them together is a narrow base of support. It is more challenging for your balance to stand with a narrow base of support.

You can reduce your base of support and challenge your balance while standing or walking.

Shifting weight and moving to the limits of stability

For good balance you need to be able to keep your stability when you shift your weight as you move. When you shift your body weight to just short of where you lose your balance you are moving to the limits of stability. If you can smoothly and safely shift your weight in either a sideways or forwards-and-backwards direction then you will be less likely to lose your balance. It is important to be able to maintain your balance when you are moving about.

Shifting your weight from foot to foot becomes more difficult as you decrease your base of support. You can make moving to the limits of stability more difficult by decreasing your base of support or by holding at the limit for a longer time.

Being able to shift your weight from one foot to the other is an important part of walking.

Stepping over objects

Safely and confidently stepping over objects is important when dealing with obstacles like gutters and uneven surfaces. You need to be able to go forwards and backwards as well as side to side.15

LiFE balance activities

A number of balance activities have been developed for the LiFE program. These activities relate to the principles of balance training.

The LiFE balance activities are:

1. Tandem stand

This is when you stand with one foot in front of the other – ‘heel to toe’. This gives you a very narrow base of support. This challenges your balance.

Tandem standing is most safely done where you have support available. For example, while at the kitchen or bathroom bench, or while standing in the queue at the supermarket with the shopping trolley.

Whenever you are standing at a bench or a counter you should try to do a tandem stand. If you cannot do a tandem stand safely you can begin with your feet slightly apart and work up to a tandem stand.

You can make tandem standing even more of a challenge by shifting your weight from one foot to the other while in this ‘heel-to-toe’ position.

2. Tandem walk

This is ‘heel-to-toe’ walking. You sould only try this where you have support available. Hallways, dining tables and kitchen benches are all good places to practise this activity, because you can use the walls or benches to support yourself as needed.

Whenever you walk along your hallway or past the dining table you should try a tandem walk. 18

3. One-leg stand

You stand on one leg while holding the other leg off the floor. You should have support available as you should for tandem standing. This activity is important because a normal part of the walking process is being able to balance on one leg as the other leg swings past to take a step forward. If you improve your ability to support yourself on one leg you will help improve your stability in walking.

You can try standing on one leg while cleaning your teeth, brushing your hair and during other activities where you are at a bench. Use the bench for support as needed.

4. Leaning side to side

Stand with your weight evenly distributed on both feet. Shift your body weight so that it is mostly on one foot and hold for a few seconds (if possible) at the limit of the shift. As you shift the weight over to one foot you are moving to the limit of your stability. You should feel like more of your body weight is going through the leg and foot that you are shifting your weight to. You shouldn’t bend at the waist.

Once you finish with one leg, shift the weight to the other foot.

5. Leaning forwards and backwards

Stand with your weight evenly distributed on both feet. Shift your weight forward onto your toes without losing your balance, and hold at that point for a few seconds. Then shift your weight backwards onto your heels and hold there for a few seconds.

You should try to have a wall behind you or a bench in front of you so that should you overbalance you have support.

19This activity is more difficult than it looks. It is a very small (and subtle) movement. You are trying take your weight forward, but not bend forward at the waist.

6. Stepping over objects – forwards and backwards

This activity is like doing a ‘high step’. You concentrate on lifting your leg up and over. You should also concentrate on lifting the leg that is following and make sure that you lift it up and over as well. As you lift the leg that is doing the stepping you will need to balance on the leg that you are standing on. When you have ‘stepped over’ forwards you should try to do it backwards. You can use support to start with if needed. You should aim to be able to do it without support.

The high step takes longer than a normal step and makes your supporting leg work harder to balance.

A good place to practise this is where there is a change in floor surface covering, for example, between the kitchen tiles and the dining room carpet. You can pretend that it is an obstacle that you need to step over.

You can make this activity more challenging by actually putting something on the floor that you have to step over. This might be an empty cereal box or a small pillow. By putting the object on the floor you will need to practise a higher step. This challenges the balance of the supporting leg. If you put something on the floor you need to remember to pick it up so that you don’t trip over it later.

By practising both forward and backward directions, you will improve your ability to negotiate obstacles when you are in a real situation. 20

7. Stepping over objects – side to side

This is similar to the ‘stepping over objects – forwards and backwards’ activity but in this one you are going to practise stepping over in a sideways direction. It is performed in the same manner as stepping over forwards and backwards, but you will be stepping sideways instead. The supporting leg does the balancing, but it works the muscles in a different way to the forward and backwards activity. This can be done in similar places to where the ‘stepping over objects – forwards and backwards’ activity can be done.

You can once again make this activity more challenging by putting an obstacle on the floor to step over.