All Posts tagged balance

Balance & Leg Strengthening

Here is a great question from Dr. Ray Sue. I thought you might want to see my response.
 
Hi Jeff,
 
I had a long time elderly patient come in that has been suffering from falls of late.  After going through a battery of tests (for her eyes, ears and CT for her brain) it was determined that she simply needs to get in better condition and gain more strength.
 
My thoughts were to work on her ankle/knee/hip balance and proprioception (with 1 and 2 legged stances with eyes open and closed), strengthen her quads (with ball squats) and her glutes with prone glute squeezes and extensions.  I’ve had her try and do sit and stands but, she definitely has trouble. 
 
Is there anything else you’d recommend or changes to what I’ve recommended?
 
Thanks so much!
Ray
 
Dr Tucker’s RESPONSE: 
I think you are definitely on the right tract. Now lets make it functional!
Additional programming could include this progression:
Single-leg (SL) Balance w/ multiplanar reach with the up leg (she can hold on to a chair)
SL, 1-arm Diagonal movements while holding a light weight in the moving arm
SL windmill moves with the arms
SL Romanian deadlift (partial movement)
Double leg squats (or 1/2 squats or just small knee bends) progressing to SL squat (or 1/2 squats, or just small knee bends) holding something (free weights) in her hands (not holding onto a chair) 
Begin lunge progression or at least stepping forwards and backwards
Begin going up and down a step
Hope this helps. 
Jeff
www.DrJeffreyTucker.com
 

More

Exercise & Pain

If we all agree that exercise is vital to health, then let’s figure out the best routine. The right mix of exercise can: Reduce the risk of premature death, reduce the risk of heart disease,  reduce high blood pressure, reduce high cholesterol, reduce the risks of many cancers, including colon and breast cancer, reduce the risk of developing diabetes, reduce fat and optimize body weight,  build and maintain healthy muscles, bones, and joints,  reduce depression and anxiety,  enhance performance in work and sport. 

Believe it or not, running every day, won’t cut it. Going to the gym every day and working out with weights every day won’t cut it. The ideal exercise program includes cardio/aerobic exercise, strength training, weight-bearing exercise, stretching, breathing, and balance.

Cardio/aerobic exercise. This has to be some movement that is brisk enough that requires the heart and lungs to work harder to meet the body’s increased oxygen demand. Basically you are forcing the heart and lungs to work harder, and yet of low enough intensity to facilitate adequate oxygen transfer to the muscle cells so that no buildup of lactic acid is observed. Think repetitive movement of the arms, legs, and hips.     Take your pick from running, jogging, and fast walking. Biking (either road or mountain), and swimming are also good. If you belong to a gym or have home equipment, there are treadmills, elliptical trainers, spin cycles, and rebounders. 

Strength Training involves the use of free weights, kettlebells, weight machines, resistance bands or some other form of resistance to build muscle and increase strength. Its benefits include: Increased muscle strength, increased tendon and ligament strength, reduced body fat and increased muscle mass,  better balance,  lower blood cholesterol, improved glucose tolerance and insulin sensitivity.  The key to strength training is to choose one you can do easily and are willing to do regularly.

Every patient of mine that wants to lose weight, I make sure that they are  doing  circuit weight training.  Strength training builds muscle which increases your resting metabolic rate. 

Weight bearing  exercise is actually a subset of certain aerobic and strength training exercises. It helps slow down the rate of bone loss and osteoporosis. It is exercise in which you force your body to support weight (your own included) while exercising.  The best weight bearing exercises are: weight-lifting, jogging, hiking with a back pack, stair-climbing, step aerobics, racquet sports, and other activities that require your muscles to work against gravity. Swimming and simple walking don’t do the trick. One exceptionally useful form of weight bearing exercise is rebounding. The act of rebounding makes use of g-forces, just like astronauts training in a centrifuge. 

Stretching is the most over-looked area of fitness I have seen lately. Stretching reduces muscle tension and increases range of movement in the joints. I see tremendous tightness and restrictions in most clients bodies from a lack of variety of movement.  Tightness and constriction cause a reduced blood flow to the muscles and soft tissues, this leads to a lack of oxygen to the tissues and this is a very painful situation. Yoga  has become one of my pewrsonal favorites for stretching. Pilates works well too. If nothing else, just do 5-10 minutes of simple stretching after your daily exercise routine as part of your cool down time. 

Proper breathing is often over-looked as much as stretching. The concept is simple: putting a device in your mouth that restricts (in a controlled manner) your inhalations and exhalations, which forces your lungs to work harder. This, in turn, strengthens the muscles that makes your lungs work and increases their capacity.  

The last area  is Balance. Balance diminishes with age unless we consciously exercise it. If you fall down and break your hip or wrist, the odds are you will have  a long-slow recovery, if you fully recover. 

The most simple balance exercise is to practice standing on one leg. If you need to hold on to a chair for support, with one hand, that’s fine. Slightly bend one leg so that  the foot of the bent leg is projected out behind you. Get used to balancing on the one leg holding a chair or wall. Then take the hands off the chair and balance with one eye closed. Build up to balancing with your eyes closed for 30 seconds. 

Please remember that you can not exercise your your way out of a bad diet. Increase your quality protein to build the muscles you are exercising.  Avoid sugar but enjoy high quality fats such as Omega-3s.

More

Whole Body Vibration Update

 A 12-week course of low-frequency vibration appears to be safe and feasible for improving dynamic balance in women with fibromyalgia, new research findings suggest.

Narcis Gusi, PhD, with the University of Extremadura in Caceres, Spain,
and colleagues reported their findings in the August 2010 issue of
Arthritis Care & Research.

As most of you know I use the Deep Muscle Stimulator (DMS) for neural and musculoskeletal rehab, but this article discusses whole-body vibration (WBV).  In WBV, a patient stands on a platform that oscillates at a particular frequency and amplitude, causing muscle contractions through stimulation of sensory receptors.

The study included 41 women aged 41 to 65 years who were randomized
either to a control group or to the vibration intervention, which
included a 30-minute session of instruction plus 3 sessions of
self-administered WBV per week for 12 weeks. Each session consisted of 6
repetitions of a 45- to 60-second, 12.5-Hz vibration.

WBV  has been shown to improve body balance and bone mass density (osteoporosis) in women. It may help muscle conditioning, endurance, and pain.

Arthritis Care Res. 2010;62:1072–1078.

More

Balance Training

This article appeared in the California Chiropractic Journal
In-Office Rehab and Balance Training by Dr. Jeffrey Tucker, DC

The doctors that I get to teach, and those that I meet who include exercise therapy in their practice appear to create better client satisfaction and experience better patient retention. Patients enjoy the participation in their care that exercise therapy provides.
More than thirty-five years ago, when I was a teenager, going to the gym and working out was for kids and parents who already had an active lifestyle. The typical ‘old school’ gym program included a ten minute bike or treadmill warm up, a 40-50 minute strength training regime—usually in a muscle group split, and then on “off-days,” 20-30 minutes of cardio.

Today’s ‘new school’ exercise programs consists of foam roll therapy (self myofascial release) for 10 minutes, stretching of overactive muscles for 5-10 minutes, core stability exercises for 5-10 minutes, balance training for 5 minutes, reactive training and speed, agility and quickness training for 5-10 minutes, intense strength training for 20-25 minutes, metabolic/cardiovascular training for 10-15 minutes and 5 minutes for cooling down.

Many clients that come to us may already be doing any or all of these exercise strategies on their own at home or in the gym. My role as a rehab specialist is to write corrective exercise programs, teach clients how to perform the exercises and guide them into progressions that help eliminate pain.

Additional therapeutic goals may include injury prevention, decreased body fat, increased lean muscle mass, increased strength, increased endurance, increased flexibility, and enhanced performance.

You can have a very successful exercise practice in your office using Therabands, especially the ones with handles, a barbell, dumbbells, kettlebells, a sturdy exercise bench that inclines, a swiss ball, a wobble board, or rocker board, or bosu.

I break up each of the “new school” categories of exercise in my in-office treatment sessions. After the acute care phase, I start by training clients in the use of the 3-foot-by-6-inchwide foam roll. This method of self myofascial release is used to inhibit overactive muscles. Holding pressure on the tender areas of tissue (trigger points) for a sustained period of time, usually 30 seconds per tender point,can diminish trigger point activity. Patients are expected to use the foam roll at home on their own. This is followed by a session where I teach clients how to stretch.

Following use of the foam roll, the application of a lengthening technique (static stretching) resets the muscle lengths and provides for optimal length-tension relationships. Once patients are foam rolling and stretching at home, the subsequent in-office session is used to teach isolated strengthening exercises. This session time is used to teach clients how to isolate and exercise a particular muscle. For example, a common underactive muscle is the gluteus medius. The side lying hip abduction exercise would be taught to increase the force production capabilities through concentric-eccentric muscle actions.

Isolated exercises focus on the muscles of the body that have synergistic function of the stabilization and mobilization system.

Additional sessions are required to train clients in integrated dynamic strengthening exercises. This will ensure an increase in intra- and intermuscular coordination, endurance strength and optimal force-couple relationships that will produce proper arthrokinematics.

An important exercise therapy often overlooked by clinicians, is that prior to resistance training, balance training should be performed, because it has preconditioning effects
on strength training. Our everyday clients face the challenges of keeping balance to perform activities such as playing with their children or grandchildren, walking on uneven surfaces or even taking a walk in their neighborhood.

‘New school’ exercise programs realize balance is a skill-related component of physical fitness. It is important to incorporate balance training in every client’s corrective exercise program as an integrated component to a comprehensive training regimen.

Balance can be influenced by many factors. As we age, our ability to balance or maintain postural control decreases. Watch seniors maneuver steps and stairs. Those who lack the ability to decelerate and control their center of gravity have a significant risk potential of a devastating fall. Prior injuries, especially after ankle sprains, ligamentous injuries to the knee, and low back pain can also decrease an individual’s ability to balance.

A joint dysfunction in the ankle, knee, shoulder, or low back can lead to muscle inhibition. An acute joint injury may cause joint swelling, which results in an interruption in the internal communication process of the body–sensory input from receptors such as articular, ligamentous, and muscular mechanoreceptors to the central nervous system. In turn, this changes our proprioceptive capabilities. When sensory input to the central nervous system is altered, our movement system may become imbalanced.
Repetitive recruitment of the wrong muscle fibers, in the same ROM/Plane of motion and at the same speed, creates tissue overload and eventual injury. Consequentially, this can lead to neuromuscular inefficiency, resulting in decreased balance and postural instability.

Recovery from injury needs to include repairing faulty movement patterns (alterations in stability) and correcting inefficient neuromuscular control. Through balance training,
the central nervous system can be exercised to change and improve a lack of joint stabilization that is causing functional instability.

Don’t forget to address balance as a component of a training program. Balance training may be used not only for reconditioning clients post injury, but also as a preventative measure to increase postural stability and reduce the chances of injury.

Dr. Jeffrey Tucker, D.C., D.A.C.R.B, is
a rehabilitation specialist, author,
lecturer, and healer best known
for his holistic approach in supporting
the body’s inherent healing
mechanisms and for integrating
the art and science of chiropractic,
exercise, nutrition and attitudinal
health. He instructs for the National
Academy of Sports Medicine and
the Chiropractic Rehabilitation Association.
He practices in West Los
Angeles, CA.

More

Improve Balance Exercises

Arch Up (Prone)

Lying on your stomach with hands along your side, palms facing up. Lift head and torso off the floor as high as possible and look up toward the ceiling. After holding for two breaths rotate head so looking toward the floor again and release the pose.

Hold for 2 breaths.
Repeat 10 times per session.
Two sets per session.
Complete 1 session per day.

Opposite Arm/Opposite Leg (On All Fours)

Tighten stomach and raise right leg and opposite arm. Keep hips level and stomach very tight and drawn in.

Hold for two breaths.
Repeat 20 times per side, per set.
One set per session.
Complete 1 session per day.

Thoracic Extensions

With or without weights, raise both arms in the “I” position, “Y”position and “T” position.

Repeat 10 times per set.
Two sets per session.
Complete 1 session per day.

Deep Squat

Stand with feet shoulder/hip width apart. Squat deeply trying to keep heels on the floor. Keep head and chest up.

Build up to 50 squats per set.
One set per session.
Complete 1 session per day.

More