Balance is a fundamental aspect of every activity we do, majority of the time it comes subconsciously. When looking closer at what balance is, we often refer to stability and motor control, and describe it as the small adjustments made within our stabilising muscle groups while our larger muscle groups propel us
forward/slow us down/change direction etc.
To maintain balance, our brains must rapidly and continuously integrate and then process the sensory information received from our visual, vestibular (innerear) and somatosensory (joints i.e. knees, ankles, spine) systems, and this integration is often worse in older people thus become prone to falls. The good news is, our stability can easily be trained and challenged in a balance situation/exercise which will improve our strength, balance and prevent our risk of falling as we age.
Rightly or wrongly, when training balance in an individual we, as an industry, often go straight to a single leg stand. I do believe a single leg stand serves a purpose in a rehab setting post injury, though when it comes to targeting balance specifically it may be better to give the individual an exercise a little more dynamic and transferrable to their activity/sport. This will give the balance drill more purpose, and require a greater motor control engagement during the exercise when compared to sticking someone in a doorway in a single leg stand. Other great examples of this may include; walking lunges, walking on a balance beam, stepping over obstacles or direction changes on an unsteady surface etc.
On a daily basis, I work with clients of all levels of balance – a simple bare foot beam walk can be very beneficial to majority of my clientele, from athletes to falls prevention groups. I often use beam walking in a superset scenario, where a client may be completing a strenuous/compound movement (e.g. squat, deadlift, walking lunge) where they will need a rest between sets. In this rest break, I will have the client to walk the balance beam as part of their recovery – its sensory motor engagement, not physically high demanding though does require activation and re-setting of our stability muscle groups. The beam provides immediate feedback for the client and the individual themselves can gauge a response on their own balance, whether they need high levels of concentration, having to look at their feet, throwing their arms about or needing to use a walking aid (rails, walker, dowels). Therefore, our stability exercises can be seen in both a rehab or fitness setting though does not need to be prescribed alone, rather in a superset to complement another exercise.
With this said, if an individual has mobility limitations throughout their body - this could be an underlying issue that may need addressing before challenging their balance. For example, if you had limited range in ankle dorsiflexion, or you’re incredibly tight through the hips, you may be observing a mobility problem that is impairing the sensory feedback in the balance activity – which, as stated above, is necessary for humans to maintain balance throughout an activity. If you assess the individual’s mobility and identify issues, it may be most beneficial to work on these mobility limitations before continuing with the balance activities – you may save time in the long run as the individual will have a greater sensory feedback, thus giving them the ability to better correct their own balance.
What about the clients who may have adequate mobility though their balance won’t allow them to walk a balance beam or complete other more dynamic balance exercises?
You could try walking a balance beam with a walking aid i.e. rails or dowels. This would give the individual more points of contact though would still create a right left reciprocal movement (i.e when they advance with one foot they advance with the opposite arm) which will complement the activity – engaging the right glute and the left latissimus simultaneously, and vice versa. The brain advantages from this reciprocal movement, having a greater motor control engagement and will transfer better into daily activities or even sports that require great stability - for example, golf, motor bike riding, mixed martial arts, surfing and everything in between.
Look at the more functional/dynamic exercises rather than the static single leg stand that we so often go to. It will carry over better in other activities at both ends of the balance spectrum – both your falls prevention group and your elite athlete group will benefit.