What is balance?
The ability to maintain the body’s position in equilibrium
What is centre of gravity
point where the body’s mass appears to be concentrated and from which gravity appears to act
Where is CoG in anatomical position?
slightly anterior to S2
What affects CoG?
body shape, weight distribution and position
What is base of support?
the perimeter of the contact area between the body and it’s support surface.
What alters base of support?
Foot placement and postural stability
What are corrective strategies and examples?
When someone is destabilised, corrective strategies are required to return CoG over BoS and prevent falling
- ankle strategy
- hip strategy
- stepping strategy
What are the three sensory inputs for balance?
- visual system
- Vestibular system (receptors in inner ear)
- somatosensory system (mechanoreceptors and proprioeception)
How does the ankle strategy work
In posterior displacement, dorsiflexion and in anterior displacement plantarflexion
Which muscles contract in the posterior displacement ankle strategy?
dorsiflexors, abdominals and quads
Which muscles contract in the anterior displacement ankle strategy?
plantar flexors, hamstrings and trunk extensors
How does the hip strategy work?
Pelvis moves rapidly in opposite direction to sway
Which muscles contract in the backward hip strategy?
hamstrings, glutes and spinal extensors
Which muscles contract in the forward hip strategy?
abdominals and quadriceps
How does the stepping strategy work?
Forwards or backwards step used to increase the base of support when displacement is too great for ankle or hip strategy
What are some causes of impaired balance?
- Amputation
- Inner ear problems
- Nerve damage
- Head injury- affecting vestibular system
- Alcohol
- Neurological conditions e.g. Parkinson’s, MS
- Visual impairments
- Lower limb injury e.g. ACL sprain, ankle sprain
- Spinal pathology e.g. low back pain
- Brain injury e.g. stroke, tumour
- Ageing
What is balance training?
Exercise programme requiring patient to maintain balance. Gets progressively more difficult within a safe balance. Can be static or dynamic activities.
How is balance training progressed?
- Supported or unsupported- hold onto something stable to make it easier.
- Bilateral or unilateral stance.
- Large base of support or small base of support.
- Partial or fully weight bearing.
- Stable or unstable surface.
- Visual input or no visual input (close eyes).
- Static or dynamic.
- No head/limb movement or head/limb movement.
- Distraction or no distraction.
- Staying within or reaching outside of base of support.
- Perturbation or no perturbation (stress or bother)
Balance training dosage
At least 2-3 days a week and 20-30 minutes per session in healthy adults.
Balance training safety
- Begin with simple and safe exercises.
- If there is risk of falling, stay close to patient, perform exercise in parallel bars or next to a stable object they can hold. Two people for very unstable patients.
- Place mats under wobble boards.
- Remove obstacles and unsafe objects
Contraindications fo balance training?
- Patients who are inherently unsafe in balance challenged positions e.g. cognitive impairments.
- When it will disrupt healing process.
- When it increases pain.
- When it increases inflammation.
What adaptations occur as a result of balance training?
- Decreased cortical brain activity.
- Increased sub-cortical activity.
- Decreased excitability spinal reflexes.
- Decreased unwanted joint reflex oscillations- improved movement control.
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Joint Mobilisation26
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Ankle Sprain20
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Heat and cryotherapy6
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Tissue repair, Pain and Inflammation19
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Ankle assessment18
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Strength Training16
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Therapeutic massage10
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Therapeutic ultrasound17
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Balance training22
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Osteoarthritis15
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Special tests33
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Muscle length tests7
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Strength exercises6
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Mobility exercises6
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Stretches6
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Walking aid gait11
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Oxford Grading Scale32
