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How to Test for Balance and Increase Functional Movement

Balance is an Essential Part of Human Movement

BalanceBalance is something that we take for granted in our daily lives. We don’t think much about it until something happens.  Slowly as we age (or quickly in the case of an injury) we notice that our balance has become compromised and it is affecting daily living activities. Learning about the principles of functional movement will not only improve quality of life, but also exponentially enhance your fitness level.

Balance is defined as the ability to maintain a position over the body’s base of support; both when stationary and in movement.  This could potentially mean the difference between maintaining a healthy active lifestyle or being sedentary.

The Principles of Body Alignment

Understanding balance means considering the principles of the bodies alignment; centre of gravity, line of gravity and base of support.

Centre of gravity is defined as the point at which the entire weight of a body may be considered as concentrated so that if supported at this point the body would remain in equilibrium in any position. The average person’s centre of gravity is the second sacral vertebra (approximately 2” above the pubic bones), however, that will change depending on their position and if he/she is holding an external weight.

Line of Gravity is gravity acting on the body in a vertical straight line through the centre of gravity. In order to maintain balance and remain stationary; the line of gravity must fall within a person’s base of support.

Base of support is the area under and surrounding the body when one continuous line connects at all points of the body in contact with the ground.

As a fitness professional or person new to exercise, it is important to find the starting point for your current level of balance and fitness. Once you have concluded where you are at now, you can begin to formulate a training program to get maximum results in a safe and efficient manner. Balance should be challenged and trained to start as a foundational component of any fitness program. The following tests will show you how to manoeuvre training variabilities so you can achieve better balance.

Romberg Test

The Romberg test is a simple and commonly used method of quantifying balance and to diagnose gait disturbances caused by abnormal proprioception involving information about the location of the joints.

Instructions:

  1. a) Remove shoes and stand with feet together. Hold the arms beside or crossed in front of the body.
  2. b) Stand quietly with eyes open, and then with eyes closed. Try to maintain balance. For safety, it is essential that someone stand close to prevent potential injury if you were to fall. When you close the eyes, don’t orient yourself to light, sense or sound, as this could cause a false positive outcome.

The Romberg test is scored by counting the seconds the patient is able to stand with eyes closed.

Note- Anyone unable to stand with feet together while eyes are open should avoid attempting to do this test. Work with an elite personal trainer or physiotherapist to establish a better base of support.

Sharpened Romberg Test

The Sharpened Romberg test is used to assess static balance by standing with a reduced base of support by placing the feet in tandem (heel-to-toe) while removing visual sensory Information

Instructions:

a) Remove shoes and stand with one foot directly in front of the other (tandem or heel-to-toe position), with the eyes open.
b) Hold arms across the chest, touching each hand to the opposite shoulder.
c) Do some practice trials. Once you feel stable, close your eyes. Have a friend or personal trainer start a stopwatch to begin the test. Have a friend or personal trainer stand close as a precaution to prevent falling.
d) Continue the test for 60 seconds or until one of the following occurs:
– loss of postural control and balance
– feet move on the floor
–  eyes open
– arms move from the folded position.
– anything exceeding 60 seconds with good postural control.
Try two trials per leg position and record the best performance on each

Standing Forward Reach With Outstretched Arm

Instructions:

  1. a) Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can.  Place a ruler at the end of fingertips when the arm is at 90 degrees.
  2. b) Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position.
  3. c) When possible, use both arms when reaching to avoid rotation of the trunk.

Results:

4 can reach forward confidently 25 cm (10 inches)

3 can reach forward 12 cm (5 inches)

2 can reach forward 5 cm (2 inches)

1 reaches forward but needs supervision

0 loses balance while trying/requires external support

Develop the Core Not Just the “Six-pack” Muscles

Once you have your baseline for your overall sense of balance and stability, then it’s time to develop your core. Your core isn’t just the proverbial “six-pack” muscles known as the rectus abdominus. It’s a group of muscles that encompass the diaphragm and deep transverse abdominal muscles which work together to help us maintain stability.

When the muscles in your core are weak frequently the hip flexor muscles take over to help with support which then leads to mobility issues in your hips such as not being able to completely extend the hip. Over time due to the compensation, it will lead to tightness and pain in the lower back.

The Four Best Core Exercises

Bird Dogs
a) Begin on your hands and knees, with a neutral spine and a tight core.
b) Using one movement, lift your right arm forward and bend your elbow bent to 90 degrees, next lift your left leg off the ground stretching out behind with the heel pressed out behind you. When your arm and leg are parallel to the ground, hold the position for five seconds, keeping your core and glutes strong.
c) Slowly return to the starting position and repeat on the other side.
Complete 2-3 sets of 12 – 15 reps per side

Side Plank
a) Lie on your left side with your weight on your left elbow and directly under your left shoulder.
b) Your body should be aligned with your shoulder hip and knee in one line, but for beginners bend the knees for greater stability.  Tighten your core and lift your hips off the ground until your body is straight (no sagging of the hips). Hold this position 5 seconds to start then gradually work up to 60 seconds.
c) Switch sides when the rep is complete.
Complete 2-3 sets
*Once you can complete 60 seconds then extend your legs straight out behind you again starting at 5 seconds and working up to 60 seconds.

Plank
a) Begin on the floor in a prone position (face-down), support your weight on both elbows, which should be directly under your shoulders.
b) Beginners should keep the knees on the floor and work on completely extending the hips so that you are in a straight line from your knee to your armpit.  Hold that position, being sure to keep your core engaged.
c) Tighten your core (deep pelvic floor muscles) and keep your back straight. Hold this position for 5 seconds to start then gradually work up to 60 seconds.
*Once you can complete 60 seconds then extend your legs straight out behind you again starting at 5 seconds and working up to 60 seconds.

Complete 2-3 sets

Glute Bridge
a) Lie on the floor in a supine position (face-up) with your knees bent and your feet flat on the floor.
b) Tighten your glutes and start to lift your hips off the floor up to the ceiling.
c) Stop when you are in a straight line from your knees all the way to your shoulders. Be careful not to overarch your back or shrug your shoulders up toward your ears.
d) Hold the position for five seconds then return to the starting position.
Complete 2-3 sets of 12 – 15 reps per side
Once you can complete all of the prescribed reps, perform the movement as described, but lift your right leg off the floor when you reach the top of the bridge, keeping your left glute muscles engaged. Return your right leg to the ground and then lift your left leg. Return to the starting position.

Everyone Should Train for Balance

Training for balance is something that anyone can do. Balance training will improve health, balance, and performance of everyone from beginners to advanced athletes. It can be done by the young and not-so-young!

Core stability or balance training is a great place to start for people new to exercise. Focusing on the core primarily at the start of an exercise program will improve overall strength and gets your body ready for more advanced exercise.  Hire a personal trainer if you are not well versed in exercise programming as they can develop something that is going to be specific to your current fitness level and will know when to progress you.

Advanced exercisers should push to perform more complex moves that both challenge your muscular strength and your aerobic stamina. Core and stability exercises should be something that you focus on throughout your life to stay functional as you age!

Happy Training!

Cathie Glennon – BCRPA/SFL, Clinical Exercise Specialist, Pharm Tech (Level 3)

References:

https://www.physio-pedia.com/Romberg_Test
https://www.sciencedirect.com/topics/medicine-and-dentistry/berg-balance-scale
https://www.acefitness.org/fitness-certifications/resource-center/exam-preparation-blog/3208/training-for-balance-training-for-life
http://www.exercisepd.com/uploads/3/5/3/1/3531021/romberg.nov2012.pdf

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