What is balance?

Balance is essential to nearly all aspects of life. Sitting upright, standing, walking, running, jumping, and playing sports all require a coordinated effort from your neurological and muscular systems. Good balance is often taken for granted throughout day to day life, but poor balance can significantly hinder your mobility and ability to participate in your desired activities. More importantly, poor balance can lead to falls and injury. Fortunately, balance can be retrained and improved with practice. 

Why it’s important

Balance, or lack of balance, is most frequently discussed with respect to elderly and falling. Studies have shown that 35-45% of individuals over 65 years old, and 50% of individuals over 80 years old, experience a fall every year. Of these falls, 5-10% results in serious injury, such as fractures, sprains, or concussions.1 As you will see below, there are many components in our skeletal, muscular, and neurological systems that influence our ability to balance and prevent falls. 

Beyond preventing falls, balance is an essential component for athletic performance and injury prevention in both contact and non-contact sports, with studies showing that improved dynamic balance is correlated with reduced risk of injury.2 Incorporating balance training is particularly significant after injuries like ACL repairs, and ankle sprains . We frequently see delayed reaction times and reduced proprioception during dynamic balance assessments, which without treatment, can put an athlete at increased risk for re-injury.2-6

Basic physiological requirements for maintaining balance:

• Proprioception – Information from receptors in your muscles, ligaments, and tendons tells your brain where each limb is in space.

  • Frequently affected following knee or hip joint replacements, ACL repairs, and ankle sprains. 

• Visual system – Our eyes transmit signals to our brain indicating if we are moving, swaying, or stationary. 

  • Frequently affected with cataracts, bifocal glasses, or near/far sightedness.

• Vestibular system –Information from your inner ear provides information to your brain about where your head and body is in space. 

  • Frequently affected by vertigo or labyrinthitis

• Muscular strength and tone – For optimal balance, we need muscular strength all the way from our head to our toes to maintain upright posture. 

• Range of motion – Limitations in range of motion, whether from arthritis or tightness throughout the muscles or tendons, can alter your ability to balance.

• Motor plans – Our body develops plans based on past experiences to help us maintain balance. If you’ve watched a young child learning to sit up, crawl, or walk, you can see how these motor plans are formed from a very young age. 

• Motor coordination – Your body may have a motor plan in place for a certain movement, but we must coordinate our entire body to react appropriately through adjustments and fine tuning of body positioning. 

• Cognitive effects– Attention, confidence, fear, and anticipation can all play into how you will balance. The more distractions you have to pay attention to, the harder it will be to balance. Imagine standing on one leg while trying to play catch, then start counting backwards from 100 in intervals of 3. These distractions can make balance much harder.  

How balance is involved in your health

A loss or reduction of any one of these systems can significantly affect your ability to balance. For better or for worse, our bodies are master compensators-- when one system has a fault, another one will likely pick up some of the slack. Compensating with other systems can typically help to a certain extent, but without training the specific problem area, you may find yourself having a hard time to feel as balanced as you used to. 

If you find that your balance isn’t quite what it used to be, you are tripping more frequently, you have fallen recently, or you have had a sports related injury, it is a great time to seek the help of a physical therapist. We can help tease out the root of your balance challenges, come up with a personalized plan to prevent future falls, and keep you participating in the activities that you enjoy. 

References:

1.     Soriano TA, DeCherrie LV, Thomas DC. Falls in the community-dwelling older adult: a review for primary-care providers. Clinical interventions in aging. 2007;2(4):545-554.

2.     Vasconcelos GS de, Cini A, Sbruzzi G, Lima CS. Effects of proprioceptive training on the incidence of ankle sprain in athletes: Systematic review and meta-analysis. Clinical Rehabilitation. 2018;32(12):1581-1590. doi:10.1177/0269215518788683.

3.     Padua DA, DiStefano LJ, Hewett TE, et al. National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. Journal of athletic training. 2018;53(1):5-19. doi:10.4085/1062-6050-99-16.

4.     Richie DH Jr. Functional instability of the ankle and the role of neuromuscular control: a comprehensive review. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2001;40(4):240-251.

5.     Kaneko F, Onari K, Kawaguchi K, Tsukisaka K, Roy SH. Electromechanical delay after ACL reconstruction: an innovative method for investigating central and peripheral contributions. Journal of Orthopaedic & Sports Physical Therapy. 2002;32(4):158-165.

6.     Kosy JD, Mandalia VI. Anterior Cruciate Ligament Mechanoreceptors and their Potential Importance in Remnant-Preserving Reconstruction: A Review of Basic Science and Clinical Findings. The journal of knee surgery. 2018;31(8):736-746.