If you’re struggling to stay balanced, you’re not alone. One of the biggest problems I see in patients over 60 is their lack of balance.
The problem is so rampant – and yet so undertreated that I wanted to tell you how great tai chi is for your balance. But, as often happens in my research, I found something better.
Before I tell you about my research, I want to tell you about two patients who illustrate just how important balance is to your well-being and quality of life as you age.
One is Margaret, a 67-year-old retired executive. The last time I saw her, she was very upset. Why? Because she knows that her balance is becoming worse. She has never fallen, but now she is starting to avoid doing things like dancing and hiking. She doesn’t feel that she can trust herself not to fall. She is losing her confidence.
The other patient is a 72-year-old man.
His name is Dick. Dick is a downhill slalom ski racer. He tells me that every time he races, the same thing happens. When he finishes the course, his time is so good that the officials inevitably call him over so that they can cross check his age again. They can’t believe that a man that old is able to go so fast in a slalom course.
Many so-called balance experts insist that Margaret needs some type of balance exercise, such as Tai Chi, to improve her balance. For years, I thought the same thing. But what you’re about to read may surprise you.
Stopping the Cycle
Maintaining a good sense of balance is the foundation of our ability to move and function independently. And unfortunately, Margaret is not unusual. The statistics are pretty bad. Sixty-five percent of men and women older than 60 experience a decrease in their sense of balance. And it’s predictable. Unless you are busy doing something about it, your balance will get worse as you get older.
Initially, the imbalance is situational and only shows up when doing skills that require a lot of balance. This can include skiing, skating, or walking on a slippery surface. Then as things get worse, the imbalance shows up during everyday activities. And the insidious thing about it all is that as balance decreases, people start limiting their activities to the point that their legs become progressively weaker. And the weakness only acts to worsen the imbalance. It’s a vicious cycle.
When Margaret started complaining about her balance, I sent her to a physical therapist who described herself as an expert in equilibrium rehabilitation. She’s one of those balance experts I mentioned earlier. Margaret went there twice a week for six weeks. The therapist showed her some stretching exercises and strength exercises. But when I talked with her after the program, she told me that it had not helped at all. Her balance was every bit as bad as it had been. So that’s when I went looking for some answers. Fortunately I found some.
It came from some new research in balance rehabilitation out of the Department of Physical Therapy in Ben-Gurion University of the Negev, in Beer-Sheva, Israel. This report gives some great information on what you can do at home to make you more like Dick and less like Margaret.
What Works and What Doesn’t
So why didn’t Margaret have good results with the physical therapy program? This report says that her physical therapist, although a specialist in the field, was not giving her the help she really needed. She considered poor imbalance to be primarily the result of muscle weakness. So her program with Margaret was limited to strengthening her leg muscles. But the actual facts go against this simplistic thinking. It’s true that some people can improve their balance by strength training. But only those who are already significantly weak.
However, most people who have balance disorders do not have them as a result of weakness. So giving them strength training exercises will at best be only minimally helpful.
A 2004 review of 62 different studies (randomized control trials) pointed this out very clearly. In this review study, the researchers looked at how effective strength training is at improving age-related balance disorders. The studies included over 3,500 patients. This review showed that progressive strength training in people with age-related balance disorders was virtually never effective.
Balance Training Works – But Only If You Do the Right Kind
This review showed that something else must be done. And that something else is balance training. But not just any kind of balance training will work. Take Tai Chi, for instance.
Tai Chi is a form of balance exercise heralding from China. It looks like Kung Fu in slow motion. Several studies have shown that Tai Chi results in a decreased fear of falling, which leads to a greater feeling of confidence. The confidence that people feel from practicing Tai Chi actually does decrease the incidence of falling. But the exercise turns out to have very little effect on computerized sway measures.
In other words, there is no actual improvement in balance per se.
Supporters of Tai Chi often quote any number of studies showing an improvement in balance in those who do it. But there is a consistent problem with all of these studies. They invariably compare people practicing Tai Chi with other practices, such as stretching and other nonspecific and nonfunctional balance exercises. We now know these other exercises are ineffective.
So here’s the bottom line regarding Tai Chi: If your balance is already good, Tai Chi (just like any other balance-driven activity, including golf, tennis, bicycling, etc.) will help you to keep it that way. But it is not likely to help anyone who already has balance issues.
What can you do, then, to improve your balance if you’re already having issues?
The In-Home Program That Solves Your Balance Problems
A complete balance program must include several progressive levels that start with simple voluntary exercises. It then has to progress to exercises that put you in situations where you will lose your balance. These situations are called perturbation exercises. And they focus on practicing the ability to immediately recover your balance after you lose it. I’ll give you some ideas for this below under step five. But first, let’s start with one very important basic concept.
As you go through the exercises, continually focus on being aware of what your body is doing. For example, notice what adjustments your body makes to maintain a fluid sense of balance when you go through the motions of sitting and standing. Notice how your weight shifts to accommodate the movement. Focus on where you feel pressure under your feet, and where body parts are located with respect to each other through a given movement. Take time to notice and analyze these points with every exercise.
One good way to do this is to have someone around to help you just in case, and go through the movements with your eyes closed. As you learn how your body achieves a given movement, you can then purposefully practice it until it’s automatic. Always keep this in mind as you go through the exercises.
In order to do these exercises, you will need an inflatable exercise ball. These look like really big beach balls. You can find them at any exercise store. They come in different sizes. Get the size that allows you to sit on the ball with your bottom about one to two inches above the level of your knees. Second, make sure you absolutely master each exercise before you move on to the next one.
(1) Sit on the ball with a wide stance (your feet at least shoulder-width apart), and place one hand against a wall or a chair to give you some balance support. Then slowly stand and then sit again. Do this until you feel you have it down. Notice what your body does to accomplish the task easily, and focus on these adjustments as you go through the movement. Then do the same thing with a narrow stance (your feet only 10-12 inches apart).
(2) Sit on the ball with a wide stance again using a chair or a wall for support. Shift your weight on the ball to the left buttock as far as possible. Then shift to the right as far as you can. Repeat with a narrow stance.
(3) Sit on the ball with a wide stance using a chair or wall, and rotate your upper body to the left and right as far as possible. Repeat with a narrow stance.
(4) Sit on the ball with a wide stance using a chair or wall, and lift one foot at a time. Repeat in a narrow stance.
This level is the same as Level 1, but you do it without using the chair or wall for support.
Don’t hold onto anything, but do these close to a wall or chair in case you lose your balance (or have someone close by to spot you).
(1) Stand with a wide stance, bend over, and roll the ball in front of you from the left to the right. As you do this, make sure that you maintain equal weight on both feet. Repeat in a narrow stance.
(2) Start with the same stance as #1, but this time roll the ball in a circle around your body. Again, be sure that you maintain equal weight on your feet. Repeat, this time shifting the weight between your feet. Repeat in a narrow stance.
Do these close to a wall or in a hallway in case you lose your balance.
(1) Stand with a wide stance. Then bend over and roll the ball forward, taking half a step. As you do this, lift the rear leg high into the air. Repeat with the other side.
(2) Don’t use a ball for this one. Slowly step forward with the right foot until your weight is fully on the foot. Then push back into a stance. Repeat, this time stepping 45 degrees to the right. Repeat, stepping 90 degrees to the side, 135 degrees to the rear, and 180 degrees (directly back). Repeat with the left foot. When you have mastered these moves at a slow speed, do them faster.
(3) Walk down the hallway, turn around, and walk back. Do this slowly, and then increase your speed as your balance allows. Then do the same thing while walking backward.
You will need a partner for these exercises. Note that the idea is to unexpectedly temporarily lose and recover your balance.
(1) Do the exercises in Level 1 while someone occasionally and unexpectedly pushes you, slightly throwing you off balance.
(2) Sit and bounce on the ball, getting up to a standing position after each bounce. Repeat, this time taking a few steps as soon as you stand up.
(3) While you are standing, have someone slightly push your body at the waist.
Resist the push and keep your feet in place. Then do the same thing while walking, being careful to resist the push and continue walking in a straight line.
(4) Stand back-to-back with someone, holding the ball between your backs. Then both of you lower yourselves by bending your knees. Do it in unison, and also not in unison.
(5) Put some 12-inch wide chair cushions on the hallway floor about two to three feet apart, and walk across them in the same way you would cross a stream by walking over a series of rocks.
Of course the best way to improve your balance is not to let it get bad in the first place. So while you still have good balance, make sure to do activities that will keep it intact. This means martial arts, yoga, tennis, basketball, golf, etc.
Continue these activities the rest of your life. Never stop, because as soon as you do, your balance is likely to suffer from it.
But if you are already starting to notice a decrease in your balance, get it back — or at least improve it — by doing these exercises every day. You should start to see a significant improvement within six weeks.
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