Do you feel that your balance is off?  Are you not as sturdy as you want to be when walking on sand for example, or tackling the terrains of a long hike? Similar to other aging phenomenons that inevitably occur throughout the lifespan such as a decrease in muscle mass or bone density, our postural control, which is essentially our ability to maintain balance in an upright position naturally declines. As a result, we become more susceptible to falls and/or potential injury. In order to prevent a more rapid decline of our postural control, we need to [P]Rehab it! In this article, we will help you understand what systems in our body play a role in postural control, and how you can utilize balance exercises to maintain optimal control of your body with your daily activities!

 

What is Postural Control And How Does It Play A Role In Balance?

Defined by Fay B. Horak in the Journal of Physical Therapy & Rehabilitation, “postural control is the ability to maintain equilibrium in a gravitational field by keeping or returning the center of body mass over its base of support”. Moreover, Neil B. Alexander discussed that postural control is an individual’s ability to maintain his or her limits of stability, which are areas in which the center of mass can move within safely without changing the base of support.

In essence, whether we actually are cognizant of it or not, we constantly are counteracting the natural gravitational forces the Earth places on our bodies! Pretty cool right? But how exactly do we do this? The harmonious team that helps optimize our postural control is comprised of three different body systems, which we will describe next.

Understanding Postural Control

 

What Helps Us Keep Our Balance?

Postural control is reliant on the incorporation of 3 main sensory systems: the visual system, vestibular system (inner ear), and somatosensory (proprioception) system.

Each of these systems must work in conjunction with one another in order to optimize our postural control. As we interact with our environment on a daily basis, we are consistently utilizing a combination of these sensory systems to ensure we keep ourselves in an upright position.

For example, have you ever woken up in the middle of the night when it is pitch black trying to find your way to the bathroom? Because your visual system, (which gives us the most input for postural control), at that time, is ‘impaired’ from the darkness, your walking capabilities are not as great as they usually are.

Let’s take another example. Have you been on a moon bounce when you were younger, or older, no judgment zone here. As soon as you step on that moon bounce, you are fighting for your absolute life to avoid falling! This is because your proprioception is being altered, which is your body’s ability to know where it is in space.

In the next part of this article, we will go into more detail about how our bodies utilize these 3 systems to maintain postural control.

 

Neck Control is Correlated With Postural Control!

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The Neck and Mid Back [P]Rehab Program is a physical therapist developed, step-by-step program that teaches you how to optimize your neck & mid back health. This program will expose you to various neck & mid back mobility, strength, and stabilization exercises supported by science. This program will bulletproof this region for anything life throws at you! Learn more HERE!

 

The Visual System

We often think of vision as to how well we can read a sign 20 feet away, or the clarity as to how we can see certain images. However, our vision plays many more important roles in our bodily functions besides the ability to see. In fact, some research such as an article by DiCarlo et. al has supported that up to 50% of our brain is utilized for visual processing. Moreover, our brain is intimately associated with our visual system.

 

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When you look at a curb for example when walking, nerve endings from your eyes that are sensitive to light transmit signals towards the back of your eye. From there, a large nerve in the back of your eye, known as the optic nerve, continues to transmit that signal up to the part of your brain that interprets vision (the visual cortex), which then interprets the size, distance, shape, and all aspects of that specific curb, so you can actively negotiate your foot up that part of your environment without missing your step! If your visual system is not working optimally, then your brain will not be able to interpret the correct information for you needed to maintain postural control.

Optic Nerve

 

The Vestibular System

The vestibular system is located within our inner ear. In addition to assisting with the transmission of sound, our vestibular system also plays an integral role in postural control. It is comprised of semicircular canals that have specific hair cells within it. As we move our heads, the hair cells within those canals move a specific direction, which send signals to the brain that is related to our head position, orientation in space, and motion. Moreover, this system allows us to stabilize our head during movements. One of the important mechanisms we utilize is the vestibular ocular reflex (VOR), which is a system incorporating our vestibular and visual systems that allows us to maintain eye gaze on a specific object as we move our heads.

Vestibular System Anatomy

What happens when our vestibular system is ‘thrown off’ or disrupted is that we begin to feel off balance and/or dizzy. For example, have you ever been on a ship before, and when you got off, you felt dizzy, or off balance? This is because the information that your vestibular system is receiving when in an unsteady environment like a boat is sending altered signals to your brain, rather than the ‘normal’ signals that system usually sends to the brain when on a stable surface.

Common conditions that can lead to alterations in our vestibular system includes benign paroxysmal positional vertigo (BPPV), Meniere’s Disease, or upper respiratory infections leading to inflammation of the inner ear, which may lead to a vestibular hypofunction. Each of these conditions are treatable with the utilization of an interdisciplinary healthcare team, which consists of ENT physicians, primary care, vision therapy, and vestibular rehab!

There is also a correlation between concussions leading to symptoms of headaches stemming from the neck region, as well as potential symptoms of dizziness and feeling off balance. To learn more about concussions, read this article!

READ: WHAT TO DO AFTER A CONCUSSION

What To Do After A Concussion prehab guys

 

The Somatosensory System

Our somatosensory system has several important roles, such as discriminating between different sensations we feel, such as temperature or pain. It also is a vital component in establishing joint proprioception, which is our body’s understanding of where it is in space as we are performing movements. As we age, our ability to detect our body position naturally declines. Literature has shown that older adults have slower and fewer motor units, leading to a lack of optimal muscle recruitment and control. But remember, we can work on slowing the rate of that decline with exercise!

Our somatosensory and joint proprioception is one of the crucial components that is trained after ankle injuries. This is because our ankle joints are full of joint proprioceptors, and when there is an injury to an area of the ankle, these proprioceptors become inhibited.

 

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So How Do We Improve Our Balance?

In order to train postural control, you first must figure out which of the 3 systems is contributing the most to your postural control deficits. For instance, if your vestibular system and somatosensory systems are both quite strong, but your visual system is weaker, you will want to start with exercises that will help to improve your visual component of postural control. Often times, you will actually be training more than one system, even all 3 of the systems, as poor postural control is often multifactorial.

Now how do we train these systems? Simply put, you manipulate the type of exercise you are performing by ‘taking away’ or ‘altering the input’ of one or multiple systems. An example would be closing your eyes while maintaining your balance, which shuts off the visual input to your brain, making you rely on your vestibular and somatosensory systems.

Note – When working on balance exercises, always ensure that you set up a safe environment. Here are some suggestions:

  • Have a chair behind you in case you lose your balance backward and/or become tired throughout an exercise

 

  • Have a sturdy surface in front of you such as a kitchen counter or dining room chair that you can hold onto in case you lose your balance or need occasional hand support

 

  • Remove other distractions or tripping hazards from the area that you are exercising in, such as shoes on the floor, loose rugs, etc.

 

Feet Together Balance – Foam Pad, Eyes Closed

Key takeaways in regards to how each system of our postural control is being challenged here from this body position are:

  • Eyes Closed: By closing his eyes, Mike is taking away his visual system.

 

  • Foam Pad: By standing on a foam pad with a narrow base of support, Mike is altering his somatosensory (proprioception) system. If you are doing this exercise at home, you can utilize a pillow to simulate the uneven surface of a foam pad.

 

Balance Exercises Using The Vestibular System

VOR exercises consist of moving your head while keeping your gaze stabilized on a specific target. You can utilize your thumb as shown in the videos below, or you can use a piece of paper against a wall if starting with simple VOR exercises. To gain a further understanding of VOR exercises, watch the video below.

Understanding VOR Exercises

Sample Neck and Mid Back [P]Rehab Program Education Video

There is the potential of VOR exercises to reproduce a feeling of dizziness, nauseousness, or just feeling off. This is a normal phenomena. However, the more you go through these exercises, overtime your body will adapt to these exercises and you will ultimately not be feeling these symptoms. Here are some tips to keep in mind when starting these exercises:

  • When starting VOR exercises, begin with a duration of 30-45 seconds. If you start to feel some symptoms of dizziness, that is an indicator to give your vestibular system a break. As you train your vestibular system, you will be able to perform this exercise for a longer period of time, and at a faster rate.

 

  • You also can utilize a metronome, which will help you work within a specific tempo/pace of moving your head. The metronome beats/min can also be increased as you progress with this exercise.

 

VOR x1 Vertical

Sample Neck and Mid Back [P]Rehab Program Exercise Video

While looking at your thumb directly in front of you, move your head from up <> down and repeat. Make sure to keep your eyes on the thumb the entire time. Start with small movements, as you feel comfortable you can increase the range of motion you go through.

 

Take Your Balance Exercises To The Next Level

If you are starting to feel more confident in your abilities to maintain balance, try these progressions!

 

Single Leg Balance on Bosu With Head Turns

This is a combination of training all three systems! Head turns are incorporating use of the vestibular system.  Below we will discuss how to perform vestibular specific exercises.

 

Single Leg Balance On Toes – Band Anti-Inversion

Want to learn more about ankle sprains and how to rehab them appropriately? Listen to our [P]Rehab Audio Experience on ankle sprains!

LISTEN: TREATING ANKLE SPRAINS

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Closing Thoughts

Yes it is unfortunate that as we become older, our body systems become weaker than they were when we were younger. However, remember, age is just a number! If you make exercise a lifestyle habit, you can continue to feel stronger than ever even as you become older! Look at Tiger Woods, who was 43 years old when he won the Masters 22 years after he won his first title at age 21, or Lebron James winning his 4th NBA Championship at age 35. The dedication to staying active allows you to take ownership of your life and dictate how you feel. In regards to balance exercises, find ways to be creative with challenging your static and dynamic balance. Moreover, if you continue to feel off balance and have not had a formal consultation with a healthcare provider, be sure to seek medical advice from a trained professional.

 

Take Ownership of Your Neck and Mid Back Health!

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Environments are set up with most things in front of us meaning we spend all day pushing. When we spend all that time pushing the anterior or frontside musculature becomes dominant and overused. To every action, there is an equal and opposite reaction. As the anterior becomes dominant the posterior or backside of the neck and mid back become weak and under-used. This is the typical recipe for neck and mid back injury. Luckily, you’ve decided to use a different recipe, one that leads to optimal health and performance!

 

References

  1. DiCarlo, J., Zoccolan, D., & Rust, N. (2012). How does the BRAIN Solve visual object recognition? Neuron, 73(3), 415-434. doi:10.1016/j.neuron.2012.01.010
  2. Jones, S., Jones, T., Mills, K., & Gaines, G. (2009). Anatomical and Physiological considerations in VESTIBULAR dysfunction and compensation. Seminars in Hearing, 30(04), 231-241. doi:10.1055/s-0029-1241124
  3. Ivanenko, Y., & Gurfinkel, V. S. (2018). Human Postural Control. Journal of Frontiers in Neuroscience.

 

About The Author

Sherif Elnaggar, PT, DPT, OCS, SCS

[P]Rehab Head of Content

Sherif graduated from Temple University with a Bachelor’s of Science Degree and a concentration in Kinesiology. He then received his Doctorate of Physical Therapy Degree from DeSales University, graduating with honors of the professional excellence award and research excellence award. After his graduate studies, he served as Chief Resident of the St. Luke’s Orthopedic Physical Therapy Residency Program. Sherif is a Board Certified Orthopedic Clinical Specialist. Sherif focuses on understanding how movement impairments are affecting function while also promoting lifestyle changes in order to prevent recurrences of injury. His early treatment interests include running related injuries, adolescent sports rehab, and ACL rehab in lower extremity athletes. He also has been involved in performance training for youth soccer players. Outside of working as a physical therapist, he enjoys traveling, running and cycling, following Philadelphia sports teams, and spending time with his family.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

About the author : Sherif Elnaggar PT, DPT, OCS

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