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Balance Exercises

Balance exercises are designed to improve your balance and proprioception (joint position awareness). It is vital to improve your ability to regulate shifts in your body’s center of gravity while maintaining control.

Balance is the condition in which all the forces acting on the body are balanced such that the center of mass (COM) is within the stability limits, the boundaries of the base of support(BOS). The overall goals of the postural control system, stability and function, are achieved through integrated CNS systems of control.

Almost any activity that retains you on your feet and moving, for example walking, can benefit you to maintain good balance. But precise exercises designed to improve your balance are useful to include in your daily routine and can aid to improve your stability.

Balance exercises have been scientifically proven to prevent injury and are an important constituent of rehabilitation following lower limb injuries. Usually, balance exercises are to be performed for 5 minutes per day in the beginning and progressed to 10-15 minutes or longer if do not cause or increase symptoms.

Balance Exercises
Balance Exercises

Functional Balance Grades

  • Grade 4 Normal Patient able to maintain steady balance without handhold support (static). Patient accepts maximal challenge and can shift weight easily within full range in all directions (dynamic).
  • Grade 3 Good Patient able to maintain balance without handhold support, limited postural sway (static). Patient accepts moderate challenge; able to maintain balance while picking up object off floor (dynamic).
  • Grade 2 Fair Patient able to maintain balance with handhold support; may require occasional minimal assistance (static). Patient accepts minimal challenge; able to maintain balance while turning head/trunk (dynamic).
  • Grade 1 Poor Patient requires handhold support and moderate to maximal assistance to maintain position (static). Patient unable to accept challenge or move without loss of balance (dynamic).
  • Grade 0 Absent Patient unable to maintain balance.

Interventions to improve posture may be classified into two categories :

  1. Interventions to Improve Static Postural Control
  1. Interventions to Improve Dynamic Postural Control

Patients who demonstrate impairments in static postural control (stability) are unable to maintain or hold a steady position for a number of reasons, including decreased strength, tonal imbalances (hypotonia, spasticity, dystonia), impaired voluntary control and hypermobility (ataxia, athetosis), sensory hypersensitivity (tactile-avoidance reactions), or increased anxiety or arousal (high sympathetic “fight or flight” state).

Typical training postures include sitting and standing (in modified plantigrade and full standing).

Postures are selected on the basis of

(1) patient safety and level of control and

(2) importance in terms of functional tasks.

As static postural control improves, the exercises then can progress to stabilizing on a moveable surface (e.g., sitting on a therapy ball). Gentle bouncing on the therapy ball provides joint approximation through the vertebral joints, facilitating extensors and an upright posture.

Patients who demonstrate impairments in dynamic, anticipatory postural control are unable to control postural stability and orientation while moving segments of the body. A number of impairments may be contributing factors, including tonal imbalances (spasticity, rigidity, hypotonia), ROM restrictions, impaired voluntary control and hypermobility (ataxia, athetosis), impaired reciprocal actions of the antagonists (cerebellar dysfunction), or impaired proximal stabilization.

As control improves, the movements are gradually expanded through an increasing range (increments of range). For the patient who has difficulty initiating or controlling

movements, the movements can be facilitated using quick stretch, tapping, light tracking resistance, manual contacts, and dynamic verbal commands.

Practice begins with movements emphasizing smooth directional changes that engage antagonist actions (e.g., weight shifts).

Training in standing includes practice of a variety of voluntary stepping movements (e.g., marching in place; anterior, posterior, lateral, or crossed side steps).

Steps can start out small and gradually increase to minilunges or full lunges. Stepping can also be progressed from tandem stepping (e.g., forward tandem to backward tandem steps) to crossed stepping (e.g., stepping forward and across to backward and across).

Upper trunk rotation and arm swing can be combined with these cross stepping movements. Elastic resistance bands positioned around the pelvis can be used to improve the strength of stepping responses.

Some balance exercise in different body positions are given as under :

  • One leg stand
  • Lunges
  • Squat
  • Stability ball
  • Step up
  • Trampoline
  • Two leg stand
  • Tubing
  • Exercises on unstable surfaces