“Loss of balance” is the second-biggest complaint (after pain) that brings people to see me for treatment. The typical story goes that when a person tries to stand—and especially when trying to walk—he/she has a tendency to loss his balance. And this poor balance leads to a fall that requires medical attention.
Now if you are a senior citizen, this tendency to lose your balance will simply be blamed on your age. (Bad posture is similarly considered by many to just be part of the aging process.) For others who have had a diagnosis such as Parkinson’s disease, loss of balance will simply be blamed on the disease. In reality, neither of these assertions has any logical basis for being true.
If aging caused of loss of balance, then everybody of a certain age or greater would have a balance deficit. Clearly this is not so. In the case of Parkinson’s disease, the deficit lies in the ability to coordinate movement. The disease does not affect any individual muscle’s strength nor the ability to balance. Now if a Parkinson’s sufferer ends up not weight bearing due to the deficits from the disease, then a balance deficit can occur. But it is the lack of weight bearing, not the disease itself, that leads to balance problems.
With these false culturally accepted views as to the cause of balance deficits, there is typically only one approach to remedy the situation: the use of assistive devices. A person who has fallen is told that he must use a cane to improve stability, and everyone thinks the problem is solved.
Here’s what’s missed by those promoting this conventional approach: By using a cane, part of the body weight that must be supported by the person’s legs is transferred to the arm using the cane. This means that part of the person’s body is being transferred from being supported by the legs to being supported by the arm. This adjustment will lead the leg muscles to weaken as they have less weight to support. And, in weakening, they are becoming more susceptible to a loss of balance. So the person slowly becomes more and more dependent on the cane, slowly shifting more and more body weight to the arm. The more the legs weaken, the greater the risk of falling. This progression will lead to the next level of upper body support: the walker.
A walker has the person using two arms to assist with support and balance. This can lead to most of the weight of the body being taken by the arms, leaving the legs to become weaker still. Over time, the person will not even be able to stand—let alone walk—without the walker, making him even more susceptible to falling. If a fall occurs at this point, the last stage is for the person to end up in a wheel chair. He loses all independence, requiring assistance for the activities of daily living. What a tragic progression from independent to completely dependent.
But this doesn’t have to be you! To eliminate the initial loss of balance and stop the progression toward the use of a cane (or walker or wheelchair), you simply need to strengthen the proper muscles of the lower extremities. You see, balance is comprised of a neurological component and a muscular component. In my 25 years of treating people with these types of functional deficits, almost every one of them had a loss of balance due to the muscular aspect of the issue.
A DELICATE BALANCE
Let’s breakdown how balance works and how you can tell whether your balance deficit is due to a neurological deficit or muscular deficit…
The concept of balance starts with understanding where you are in space. This is achieved through the neurological component primarily occurring in the ears with the semicircular canals. These tube-like structures are aligned to the three planes of axis that make up space. One runs front to back, one runs vertical and one runs horizontal. When you try to exist in any position other than completely flat on a surface, your position in space will be measured by sensory organs that exist in the three canals. Since they are measuring you from three different planes, it allows the brain to sense where you are in space with pinpoint accuracy, and you are able to remain upright and stable. If you have ever had an inner ear infection and the semicircular canals are affected, you know the feeling of trying to sit up and your head feels like you are spinning. That dizzy, disoriented feeling occurs because the brain can’t pinpoint where you are in space.
Self-test: To see if your balance deficit is occurring due to a neurological deficit, simply sit up straight in a chair with absolutely no support from your hands or leaning. Do you feel stable when doing so? If you are stable, then the neurological aspect of your balance is intact. The only difference between being stable in sitting and unstable when standing or walking is that the latter two activities require support of the legs.
Let’s say that your neurological aspect of “balance” is intact but you start to lose your balance when you stand or walk. When your sense of where you are in space tells you that you are not stable, your brain will send signals to the muscles that support you and try to get them to contract to move you back to a stable situation. If the muscles are simply not strong enough to make the corrective maneuvers, you will fall. So here, the loss of balance is really due to a lack of strength. That is why I promote the view that for most people, their “balance issue” is really a weakness issue.
A WEAK ARGUMENT
For most people their loss of balance is a side-to-side problem. When they start to walk, they move toward one side until they lose their balance and fall. This type of deficit is indicative of a weakness in the gluteus medius. This muscle sits on the side of the pelvis and attaches from the pelvis to the hip joint. It is designed to pull your pelvis and torso to the outside of your body.
Because your body sits to the inside of either leg you would stand on, the tendency is for the body weight to pull you toward the opposite side of your body. When your gluteus medius muscles are strong, they create enough force toward the outside of the body so that this doesn’t happen and you can maintain balance.
AND NOW…THE REMEDY
Logically, the key to stopping a loss of balance to the side is having strong gluteus medius muscles. To strengthen these muscles, you need to perform hip abduction, exercise 1 in this article.
The other common balance deficit is falling forward. This is typically due to having too much of your body weight in front of your feet. A person who is hunched forward can eventually get her body weight far enough in front of her ankle to where she is weight-bearing too much on the balls of her feet.
As you walk forward, the tendency to move forward increases until momentum makes it too difficult to control the movement forward and the person falls forward. This problem can be corrected by altering the muscle imbalance that leads to the forward body weight; namely the imbalance between the hip flexors (front groin) and quads (front thigh) versus the gluteus maximus (buttock) and hamstrings (posterior thigh). To resolve this deficit, perform hamstring curls and hip extensions—exercises #1 and #2 in this article.).
For each of the three exercises, do three sets of 10 repetitions (resting 45 to 60 seconds between sets) and repeat the workout three times a week with a day between workouts.
Regardless of the “balance” deficit that exists, addressing the appropriate muscle weakness or imbalance is the key to ending the cycle of imbalance without ever going down the path of progressively more debilitating types of assistive devices.
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