We are often told that balance is the key to life, as such balance exercises may be the key to successful injury rehabilitation.
Balance, or proprioception, is often referred to as the sixth sense, allowing us to perform actions without thinking about them.
When you are walking down the street you tend not to be watching where you are putting your feet and can reflexively adjust a stumble or a trip to avoid falling. Similarly, frequently performed actions or sports often become automatic actions such as the movement of kicking or catching a ball or swinging a golf club. We often refer to this as having a “good feel” for the event, this feel is actually our Sixth sense called proprioception.
This ability is the result of repeated actions that co-ordinate multiple systems in our body.
Essentially this sense allows us to be unconsciously aware of where our body is in space and how we successfully react to changes in the environment. This allows us to perform a task with skill, accuracy and efficiency without constant thoughts.
It is reliant on the interplay of information received from various body parts including;
- Eyes: Our visual system is important in relaying information about where we are in space to the brain. This is why we get people to shut their eyes in balance training as they have to rely more on the information coming from their inner ears and joints.
- Inner ears: This is where your vestibular system lives and is important in the effectiveness of your balance system. Changing your head position will affect the position of the inner ear and in turn, changes the information going to your brain. This is why changing head position can really challenge the simplest of things, such as standing on one leg.
- Conditions of the inner ear such as BPPV, inner ear infections, menieres disease all affect the vestibular system resulting in altered proprioceptive balance.
- Muscles, joints and ligaments; These structures in our body are not just responsible for holding joints together or helping us move. They also play an important role in feeding back to the brain information about where our limbs or body are in relation to our environment.
- Brain and Spinal cord
This information from the above areas is then processed in the higher centers in the brain. From this, we can then act accordingly to perform an activity accurately or prevent us from tripping or falling. This happens very very quickly and at a subconscious level. It is often referred to as being reflex in nature.
Much more to balance exercises than wobbleboards and ankle sprains.
When we think of retraining balance we often regard it as the domain of the sprained ankle or knee ligament injury. It is true that these injuries commonly affect our proprioceptive sense and often have to be rehabilitated.
However, it is also a system commonly compromised in shoulder instability or dislocated shoulders, whiplash injuries of the cervical spine and persistent low back pain.
Not rehabilitating your proprioceptive skills can lead to less than optimal outcomes.
One of the statistics that keeps running through my head is that the biggest predictor of spraining an ankle is the incomplete rehabilitation of a previous sprain. Without getting all nerdy ,there is similar evidence with regards to knee ligament injuries , especially with regards to ACL knee reconstructions.
Certainly persistent neck pain following whiplash type injuries often have deficits in their proprioceptive abilities.
Exercises also have to change to reflect the desired outcome for the client and the situations they want to get back to. The requirements of a netball player with a sprained ankle will differ from a surfer with an ACL reconstruction or a person with a total knee replacement.
Much the same, a football player with a dislocated shoulder may require a different approach than an older individual with an old torn tendon or arthritic shoulder.
To improve or train this system we have to challenge it.
Sean Connery sums it up best , and i’m not talking about his opinion on haggis
The good news is that this system is very trainable just like strength and endurance, and no matter what you are doing you will be challenging it to a degree. However, as with any exercise you have to keep on challenging yourself to progress and reach your ultimate goal. This is the art of rehab and is also the fun part as we can start getting very innovative as the videos below demonstrate.
Thanks as always for reading! Now go back and read it again but stand on one leg with one eye close and your head tilted to the left.
P.S. DO NOT TRY THESE EXERCISES AT HOME