HEALTH & WELLNESS

A balanced fitness regimen includes balance training: Here's how to do it

Most of us don't think about balance until we lose it. But physical stability is integral to our survival and well-being, says Robbin Howard, assistant professor of physical therapy at USC.

"Balance keeps us upright and allows us to do all the many things in life we want to do," she says. Without it, we couldn't stand, walk or focus our eyes on a sea gull soaring by — let alone traverse a slack line, play tennis or throw a baseball.

And though under normal conditions maintaining balance is almost as automatic as breathing, it's only through the complex interaction of multiple body systems working together that we are able to do something as simple as standing on two feet.

Even when standing "still," we rely on proprioceptors — nerve receptors in the muscles, tendons, ligaments and joints of our feet and ankles that communicate sensory signals to our brain, which responds by sending impulses that fire subtle muscle movements in our lower limbs to keep us balanced. At the same time, we rely on information from our vision as well as our vestibular system (the motion-detecting organs burrowed deep within each ear) to orient where we are in space.

Like all body systems, balance tends to decline with age. Vision decreases over the years, as does sensitivity in the bottoms of the feet. (Studies show that after age 40, foot proprioception begins a steep decline.) Minuscule hair cells within the fluid-filled canals of the vestibular system also degrade over time, dampening signals that relay head position and motion.

A number of medical conditions may also affect stability, such as diabetes, which can damage nerves in the feet, as well as vestibular problems, which make people feel dizzy and can be caused by viruses, acoustic tumors, inflammation, side-effects of certain medications or the displacement of otoliths — tiny "ear rocks" that help hair cells of the inner ear detect position changes.

To make matters worse, as strength and agility decrease with age, it's more difficult for people to right themselves when they stumble. According to the Centers for Disease Control and Prevention, 1 in 3 adults older than 65 falls each year — often resulting in head trauma, hip fractures and admission to nursing facilities. In 2013, about 25,000 older adults in the U.S. died of fall injuries.

But this fate is not necessarily inevitable, experts say. "We lose balance because we don't challenge ourselves," says Ryan DeWitt, a physical therapist in Santa Cruz. "Just like challenging our minds with crossword puzzles, we need to challenge our balance with new ways of moving."

Unfortunately, fear of falling is one of the things that keeps people from trying new moves — and this tendency toward sedentary behavior decreases balancing capability.

"If we become more sedentary, we get less input from all of our systems," Howard says. But, she adds, the reverse is also true: The more we move our bodies, the more we stimulate our balancing systems — and the more we can increase stability.

A study at the University of Connecticut School of Medicine showed that, after three months, older men and women who engaged in balancing exercises were able to regain a level of stability equal to someone three to 10 years younger. But no one has to wait until old age to reap the benefits of balance training; studies of adolescent athletes demonstrate that balancing exercises not only improve measures of stability but also protect against sports injuries, such as ankle sprain.

When practicing balance poses, "it's OK to sway," says Jessie Hess, director of Pleasure Point Yoga in Santa Cruz. "Rather than trying to become a still statue, allow for gentle undulations and articulations of the toes, feet and ankles as you create subtle movements to maintain balance."

She adds that gazing steadily at an unmoving object will help you find stability.

If a pose feels easy, Hess recommends challenging yourself by closing your eyes — even just for a few blinks. The pose will probably feel much more difficult, but the more you do it, the better you'll get.

Exercises to improve your physical stability

If you want to increase your physical stability, it's important to stimulate your proprioception (the awareness of your body position) and your vestibular system (the equilibrium organs in your inner ear), as well as strengthen the muscles that help you recover from a sway or stumble. Here are some exercises to try:

Heel-to-toe walk

Standing barefoot, lift your heels up and down a few times and feel your foot, ankle and calf muscles moving. Notice the joint articulations between the bones of your feet and ankles. Now place one foot in front of the other, heel to toe, as if you were walking a plank. Continue for 10 steps, keeping your shoulders back and your chin level, focusing your gaze on an immobile point in front of you. Next, try the exercise backwards. For more challenge, try it with your eyes closed. You can also experiment with walking in a straight line forward and backward on tiptoe.

At first, practice heel-to-toe walking on a firm, flat surface, such as a hardwood or linoleum floor. If you find that easy, you can progress to a carpeted floor, a lawn or a foam balance pad. If you're ready to move to a more challenging level, try laying a two-by-four on its side and "walking the plank" forward, backward and with your eyes closed.

Tree pose in phases

A one-legged stance is the classic balance-training position, and the tree pose is a classic standing posture of yoga. By practicing tree pose in successive stages, you can work at a stage that's comfortable for you and move on to the next stage as your balance improves. Jessie Hess, director of Pleasure Point Yoga in Santa Cruz, offers cues for yogis of all levels:

Begin standing next to a wall, where you can reach out for support anytime you need it. (After you can comfortably balance in a stage without support of the wall, you are ready to move on to the subsequent stage.)

1. Stand tall with feet parallel, toes outstretched and planted on the floor. Place your hands on your hips. Now bring your left heel to your right ankle. Rooting down through your standing foot, lengthen through your spine to the crown of your head. Next, let your shoulder blades soften down your back as you bring your hands together at your heart. Make sure to keep breathing as you focus and soften your gaze on a point in front of you. If this challenges your balance, stay here.

2. If you feel steady, you can use your hand to place your left foot on your calf. Gently pull the left knee back, keeping it on the same plane as your body. Your hips should be even. Placing your hands on your hips, continue rooting into the standing leg while lifting up through the spine. Practice engaging the standing leg so the quadricep muscle contracts and the tailbone lengthens. With your breath and gaze steady, you can experiment with bringing your hands to your heart. If that feels comfortable, try raising your arms overhead as if they were the branches of a tree.

3. For the next stage, use your hands to place your left foot on your right inner thigh, well above the knee. Next, place your hands at your heart, breathing and focusing on your balance point. Actively press your foot against your inner thigh and, at the same time, press the thigh against the foot. As you feel your strength awaken, lift up through the midline of the body and raise your arms overhead. For more of a challenge, try lifting your gaze to the ceiling or shutting your eyes.

4. Coming out of whichever stage of the pose you are in, exhale as you bring your hands to your heart, then hands to hips. Release your leg and shake it out. Repeat on the other side.

Functional exercises

A good way to work balance exercises into your life is to incorporate them into activities you do every day. Here are some ideas:

1. Try standing on one foot as you brush your teeth. You can hold for one minute as you brush your teeth on the left side of your mouth, one minute as you brush your teeth on the right side. (This will not only improve your balance but also ensure that you spend adequate time brushing.)

2. Instead of sitting down to pull on your socks or pants, try dressing your lower extremities while balancing on one foot. You can do the same while drying each leg after a bath or while applying lotion.

3. Work on strengthening your balancing muscles as you clean your house. Instead of bending down to pick up objects from the floor, use your quadricep muscles to squat, keeping your spine straight, your tailbone down and your legs wide. Practice squatting as you pick up laundry baskets, grocery bags or reams of paper. (Not only will your legs get stronger but also your lower back will thank you.)

4. Spend time walking barefoot around your house or yard. While thick-soled shoes protect your feet, they also reduce the proprioceptive input your brain receives. A study in the Journal of the American Geriatric Society showed that walking barefoot on cobblestone mats improved balancing skills in older adults. Play with reawakening the proprioceptors in your feet by walking barefoot on grass, sand or a gentle cobblestone path.

5. Consciously incorporate new movement into your life. Anytime you're walking and moving your head around, you're stimulating the vestibular system, so make time in your life for hiking, dancing or racquet sports, or actively playing with pets or children.

Tools that help with balance

A common misperception is that balance only involves standing on your feet, says Ryan DeWitt, owner of DeWitt Physical Therapy in Santa Cruz. To demonstrate, he lies on the ground, knees bent and feet down, his back resting lengthwise on a log-shaped roll of foam — then he invites me to try.

I find out right away that to keep from toppling over, I have to engage all my muscles. When DeWitt instructs me to close my eyes and lift one foot off the floor, my entire body starts shaking and I feel the roll wobble beneath me as I teeter to each side, gripping from my core to stay aloft.

"Balance is the ability to maintain stability over our base of support," explains DeWitt. "By changing the support, we can challenge our balance skills while strengthening different muscle groups."

And that's where an array of balancing tools — and a little creativity — come into play:

Balance pad: A balance pad adds a surprising challenge to balancing postures while offering the comfort of a squishy foam surface. Yoga poses that seem easy on a hardwood floor or traditional yoga mat are much more difficult to sustain on the compliant surface of a balance pad. Try standing on one foot, which is akin to one-legged balancing on a trampoline, or feeling your core and leg muscles engage when you kneel on one knee with your arms raised. For another core strengthening posture, you can kneel on all fours, raising your right leg behind you with your left arm outstretched in front of you; hold for several breaths, then switch. Virtually any position that you've mastered on hard ground will turn into a stability challenge on a balance pad. (Airex balance pad, $50-$200, depending on size.)

Wobble board: There are two types of wobble boards; each wobbles when you rest your weight on it. A rocker board consists of a flat, square base atop two curved "rocker" supports (akin to a rocking chair); a multiplaner consists of a flat, round base atop a single, rounded pivot point. When you stand on a rocker board, it rocks side-to-side (or front-to-back, depending on your orientation) in one plane of motion. When you stand on a multiplaner, it wobbles in all directions. On either, you can try supporting yourself in a plank pose — with your hands resting on the board or with your feet on the board and your hands on the floor. (TheraBand rocker board or wobble board (multiplaner), $117)

BOSU ball: A BOSU ball is extremely versatile, with two sides that offer very different bases of support. It's basically half of a stability ball, with one rounded, inflated side resting on a flat, firm base. Standing on the squishy side, you can do standing balances, jumps and ball tosses, or a variety of sitting balances, abdominal exercises or plank poses. Turn it over, and you get a solid surface resting on an unstable balance point, creating an experience similar to that offered by a multilplane wobbler board. (BOSU, starting at $129.95)

Indo board: For balance aficionados only, the Indo board lifts the wobble board to a new level of instability. With an oblong wooden board resting upon a roller with grips, it's extremely difficult for first-time users to stay on their feet, let alone maintain balance atop a moving point of support. That's probably why surfers and skateboarders seem to love Indo boards — for staying in shape and practicing tricks on days when the waves are flat. For newbies, Indo offers an inflatable cushion that can replace the roller beneath the board, turning the Indo board into a balancing surface similar to a BOSU ball with the ball side down. The more you inflate the cushion, the more unstable the Indo board becomes. (Indo, dtarting at $125 with cushion, $155 for original with roller.)

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