Balancing Act

By Gill Scheepers

The term balance is usually associated with a balance between work and family, or between exercise and rest, however balance in the physical sense of the word is an underestimated component of fitness, and one that should not be neglected when it comes to an exercise programme. While we may spend time focusing on improving strength and cardiovascular fitness, perhaps adding in some stretching and flexibility training, balance training is something that is all too often ignored.

What is Balance?

Balance can be divided into two components, namely static balance which is the ability to remain motionless about a fixed position, and dynamic balance which is the ability to remain motionless about a fixed position, whilst simultaneously completing a physical action/movement. Good balance can be defined as the ability to remain upright and steady with an even distribution of weight.

The term proprioception is important when discussing balance. Proprioception is the ability to sense where the body is in space, or in other words, our internal sense of balance and body position. It provides us with a sense of body awareness and can be thought of as almost a ‘sixth sense’. It allows you to recover when you may stumble over an object or to fall with a minimum amount of injury as your body subconsciously makes adjustments to restore its sense of balance. A proper sense of balance is a survival necessity.

The proprioceptive system uses stretch receptors and pressure receptors situated in our muscles, joints and skin to inform our brain about our physical environment and how we are interacting with it, and then to provide subconscious adjustments and corrections to keep our body’s in a safe and stable position.

A large percentage of these receptors are in our feet; which makes sense as they are the parts of our body most in contact with our physical environment. If we reduce the sensory feedback from our feet to our brains by wearing thick, shock-absorbing soles then the brain has less information to work with, thus reducing the quality of the movement pattern produced. Taking this into account, it may be a good idea to perform balance exercises bare-foot, just make sure that you are in a safe environment with no sharp objects around.

Good balance and proprioception is dependant on the body’s vestibular system (located within the inner ear- the reason why you may feel a lack of balance if you have an inner ear infection), the visual system and the musculoskeletal system. These systems all work together to maintain balance.

The vestibular system uses a complex mechanism in the inner ear to help the brain sense position and movement (i.e. up and down, side to side and circular movements). The visual system uses our sight to tell us where we are in relation to our surroundings- you can test this by closing your eyes while standing and feeling how your sense of balance changes. The musculoskeletal system provides the ability to stand, move and sense positions and movements through our muscles and joints, and to adjust the position of the body to maintain balance, this occurs throughout the day without us even realising it. If you stand still, preferably with eyes closed, you will feel how your body shifts and moves around to maintain balance, a mechanism known as postural sway.

Maintaining a good sense of balance is important for your survival. A lack of balance can lead to injury, accidents or an inability to respond to changes in your environment. Poor balance leads to a fear of falling, which results in fear -related avoidance of many day to day activities. This can ultimately lead to a lower quality of life, something which should be avoided. There are many things which can impair your sense of balance. Illness is one the most common causes of a loss of balance and can affect almost anyone (anything from an ear infection to more serious neurological illnesses such as Parkinson’s disease).

Balance training challenges body equilibrium and teaches the sensory receptor and motor systems to rapidly integrate and perform highly skilled movement patterns in a safe and balanced manner.

Consequences of Poor Balance
A lack of balance is often associated with an older population; however it is just as important in the younger, as well as athletic population. Although a lack of balance is one of the key reasons for falls in the older adult population, a lack of balance and proprioception in the younger population can not only cause injuries, but also predispose to re-injury, if not properly addressed and corrected.

Benefits of Balance Training

·        Strengthens muscle stabilizers-postural muscles, if you are prone to ankle sprains - then regular balance training can help to prevent and correct this.

·        Decreased incidence of lower limb (predominantly knee and ankle) injuries in athletes. -football players with inferior balance experienced four times the amount of ankle injuries compared to those athletes with satisfactory balance.

·        Decreased incidence of falls in older populations

·        Decreased chance of injury recurrence, if balance is  restored following a fall or injury

Exercises to Improve Balance and Proprioception
Exercises which are targeted at improving balance and proprioception are simple and time efficient, and can be easily and often rapidly progressed. Effective exercises challenge the vestibular (inner ear), visual and musculoskeletal systems. Try and spend a few minutes at the end of your training session performing some of these exercises.

Single Leg Stand with Eyes Open:

·        Stand on a stable surface.

·        Transfer your weight to one leg and squeeze the standing leg glute.

·        Lift the opposite leg up, so you are balancing on one leg.

·        See if you can hold the one-legged stance position for 30 seconds.

·        Swop sides to balance on the other leg.

·        Repeat a few times.

Progression:

·        Perform the same exercise with the eyes closed.

·        Perform the same exercise standing on an unstable surface, such as a wobble cushion, a BOSU, a thick exercise mat or pillow.

·        Hold the single leg stance position and turn the head to look from side to side and look up and down.

·        Hold the single leg stance position and reach down to touch your toes, while trying to maintain a balanced position.

·        Hold the single leg stance position and bend the standing leg into a squat without losing balance.

Balance is a multi-sensory activity. Our “sense” of balance, is based on the proper functioning of the vestibular system in close conjunction with our visual, motor skills and positioning (proprioceptive) systems. Body position, muscular-skeletal control, tactile feedback, motor coordination and visual processing inputs all combine to form a “multi-sensory network” with many functions. This seamless system of inputs and feedback must work precisely to form what we call our sense of balance.

 

Common causes and prevention for knee injuries in sports

By Adam Stein

The prevalence of knee injuries is becoming more and more common amongst social, amateur and professional sportsman worldwide. It is seen in the likes of social indoor soccer to the profession level of Australian star Quade cooper in the 2011 rugby world cup.

The most prevalent knee injuries are the ACL tear (Anterior cruciate ligament) and medial meniscus tears. These tears can be partial or full tears. After an ACL or meniscal tear generally surgical intervention will be needed to get the sportsman able to return to sport.

Common causes for Knee injuries

• Poor lower body flexibility ( especially Hamstrings)
• Improper lower body muscular strength
• Imbalanced Biomechanics
• Incorrect sports equipment ( Soccer studs too long)
• Playing sports when unfit or unprepared , (this lead to rapid fatigue of stabilizing muscles)
• Inadequate warm up

How to prevent knee injuries

• Always warm up properly before playing any sport
• When doing gym training do not leave out lower body exercises , incorporate compound exercises for adequate strength such as squats and lunges and include isolation exercises such as knee flexion and calf raises.
• Maintain correct lower body flexibility, stretch after playing sport and after all gym workouts.
• Avoid overtraining and “listen to your body” if you are feeling sore do not exercise and allow for recovery.    
• Include proprioception and agility training into your gym training routine.
• Before playing sport after a long break ensure sport specific exercises and polymerics have been done so the body is ready to take on all the demands of your sport.

Can Exercise Help People Who Have Parkinson’s?

By Tanya Bellon, Biokineticist

What is Parkinson’s?

Parkinson’s is a progressive neurological disorder caused by a decrease in the neurotransmitter, dopamine, in a part of the brain known as the substantia nigra. The decrease in dopamine is due to the death of dopaminergic cells. There are no known causes of Parkinson’s, however genetics and environmental factors have both been considered as contributing factors. Other contributing factors are aging, autoimmune response as well as mitochondrial dysfunction.

Common symptoms of Parkinson’s:

·        Tremor

·        Slow movements

·        Rigidity in joints

·        Shuffle walking

·        Freezing while performing an exercise, pauses before initiating movement e.g. chair rocking before standing, recurring falls.

·        Absence of associated movements e.g. no arm swing while walking

·        Loss of facial expressions

·        Activities of daily living (ADLS) are affected e.g inability to cut food, difficulty swallowing, rising from a chair, dressing or bathing

·        Speech – volume control and understandability

Symptoms do not appear until 80% loss of dopaminergic cells.

How does Parkinson’s affect exercise?

People with Parkinson’s experience fluctuations in their symptoms depending on exercise and changes in position. This is due to the autonomic nervous system dysfunction, which affects their thermal regulation. This leads to altered heart rate and blood pressure.

The efficiency of the exercises that are performed decreases due to the slowness of movements and rigidity that is common amongst people with Parkinson’s. This leads to an increased heart rate and oxygen consumption. Akinesia (freezing) may make certain activities more difficult to perform.

Tip 1

Don’t exercise in intense heat or get very hot when exercising.

Tip 2

Exercise when your medication is at its peak circulation in your body.

Tip 3

Getting out of a chair! (This is for everyone)

Next time you feel you are rocking yourself out of a chair, I want you to stop, move towards the edge of the chair, make sure your feet are firmly on the ground, shoulder width apart,  take a nice deep breath in and stand up as you breathe out, pushing your weight through your heels.  Try it!

Can exercise change the brain of a Parkinson’s patient?

Due to the lag time between loss of neurons and symptoms becoming noticeable, patients only get help once their condition is at a progressive stage. However studies have found the brain is malleable and compensates for the changes. The brain reshapes itself in response to experience this is known as exercise-dependent neuroplasticity. Exercise may contribute by maintaining old connections, form new ones and restore lost ones.

Exercise performed at the correct intensity can maintain certain connections and possibly improve certain activities of daily living. Exercise needs to be performed at the correct intensity, specificity, difficulty and complexity in order to improve motor skills like walking and balance. These two motor skills are very important in preventing falls. Research suggests that exercise increases the amount of binding sites (D2 receptors) on the receiving cells of dopamine signal. This enables the signal to be passed more efficiently, reducing the amount of dopamine left in the synapse between the cells. This indicates that the signal is finished, therefore reducing the amount of Parkinsonian symptoms e.g. tremor.

Exercise has also been shown to help with the regulation of the glutamate molecule that signals between brain cells. Dopamine keeps glutamate at lower levels.

In Parkinsonian animal research it has been found that with the decrease in dopamine, there is a build - up of glutamate which damages cells that control body movement. Animal exercise studies indicate that exercise may play a role in normalizing the glutamate levels.

Suggested modalities of exercise for someone who has a movement disorder like Parkinson’s

·        Walking or Swimming

·        Aqua aerobics

·        Stretching

·        Activities of daily living

Additional exercises that would be performed in Biokinetic therapy:

·        Balance exercises

·        Steps

·        Stepping over items

·        Functional exercises e.g. buttoning a shirt, picking up marbles, tying shoe laces, standing up from a chair, getting on and off the floor

·        Hydrotherapy (water therapy)

·        Walking on treadmill or bike depending on stability and progression of Parkinson’s

The verdict is still out on how this condition is caused and whether or not exercise can help people who have Parkinson’s. From a Biokineticist’s perspective, exercise is an essential part of a patient’s management programme, as it not only reduces falls, but also empowers the patient to think he/she is in control of his/her body and not the disease.

Please consult with your neurologist or consult with a medically trained biokineticist before starting any new exercise regime.