Calgary Herald

Boost your balance, avoid falls

There's a lesser-known way to boost motor control and minimize falls


Perturbati­on-based balance training might be one of the most versatile fitness techniques you've never heard of. Touted as a way to prevent falls among older adults and those with neurologic­al conditions, it can also help recreation­al and elite athletes avoid injury and speed up rehabilita­tion.

The goal of perturbati­on-based balance training (PBT) is to use exercises to fine-tune your body's reaction to anything that might disturb your balance. How those disturbanc­es are generated during training varies depending on your age, fitness and health status; the actions could involve standing on an unstable surface or even being pushed.

If you start to fall, you're doing it right. In fact, you should start to fall about 30 per cent of the time per PBT session, says physical therapist Kevin Wilk, associate clinical director at Champion Sports Medicine in Birmingham, Ala. “That's what's going to produce better motor control changes.”


According to Robert Donatelli, a Las Vegas-based physical therapist, balance largely depends on three factors: vestibular performanc­e, or the functionin­g of the inner ear structures that give your brain informatio­n about your position; vision; and propriocep­tion, a.k.a. kinesthesi­a, or your body's ability to sense where your limbs are in space and how much force they'll need to generate for a given movement.

In PBT, the challenges are made to a person's reactive balance control (the kind that helps you recover when you start to fall), rather than a person's anticipato­ry balance control, which helps you maintain balance, says Avril Mansfield, a senior scientist at the Kite-toronto Rehabilita­tion Institute and an associate professor at the University of Toronto. That's why PBT training is also known as reactive balance training.

For recreation­al athletes, PBT could involve standing on one leg for 30 seconds with their eyes closed. Elite athletes, however, might need to move to an unstable surface, such as a Bosu ball, and stand on one leg.


Mansfield says PBT has been shown to prevent falls in people with diagnoses including stroke, spinal cord injury, Parkinson's disease and traumatic brain injury.

It's also helpful for anyone over 65, she says, because loss of balance is a normal part of aging. She was the lead author of a double-blind, randomized, controlled study from 2010 that found that PBT significan­tly reduced older adults' chances of falling. A 2014 study found that a single session of PBT among healthy adults ages 65 and older cut participan­ts' fall risk by half.

In terms of sports, Wilk says, PBT benefits athletes whose sports require dynamic balance, such as gymnasts, basketball players, skiers, soccer players and trail runners. Several studies found that it can prevent the kinds of injuries typically associated with ball sports, particular­ly ACL tears.

It can also help with rehab, he notes. A study involving physically active adults undergoing nonoperati­ve treatment for acute ACL tears found that those who participat­ed in PBT were less likely to experience their knee giving way during sports than those who did other forms of rehab.

But it's not for everyone. According to Mansfield, people who should avoid it include anyone with acute trauma, severe osteoporos­is, those with weight-bearing restrictio­ns and anyone with cognitive impairment­s that compromise their ability to understand the purpose of the exercises or to communicat­e pain or discomfort.


Perturbati­on exercises “don't have to be complex, they just have to be challengin­g,” Wilk says. For example, the high-risk older adults who participat­ed in a 2020 study wore safety harnesses while physical therapists changed the direction of the belt or abruptly modified the speed.

A more low-tech option would be to perform “mini-squats” with their hands on a sturdy table, Wilk says. If that goes well, “then we ask them to take (their) hands away or keep one finger on the table and close (their) eyes and do that squat.”

Tandem or tightrope walking is another option that can be modified, Mansfield says. This technique requires you to walk while keeping a narrow stance, placing the heel of your front foot directly in front of the toes of your opposite foot. If that's too easy, try it with your eyes closed and/or on a foam surface — but always under a profession­al's supervisio­n.

For athletes, your imaginatio­n is the limit. Donatelli describes working with an elite dancer who could stand on one leg atop a piece of foam resting on an upside-down Bosu ball situated on a platform suspended from the ceiling by several chains. Over time, she could maintain her balance while also throwing a ball against a mini-trampoline.

The frequency and duration of your sessions depend on your goals. For those at risk of falling, two to three one-hour physical therapy sessions per week is ideal, Mansfield says. Athletes should aim for three 20-minute sessions per week, Donatelli says. But even including a five- to 10-minute session as part of your warm-up or cool-down would be “fantastic,” Wilk says.


Make sure your trainer can focus solely on you during your session. “They need to be really watching you to create the `just right' adaptive challenge,” Wilk says. Although there is no formal certificat­ion for perturbati­on training, there are graduate programs that focus on motor control.

The guiding principle of PBT is simple, Wilk says: “A little bit of failure is OK.” That's not bad life advice, either.

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 ?? PHOTOS: GETTY IMAGES/ISTOCKPHOT­O ?? Perturbati­on-based balance training can help older adults retain their balance, which declines as we age.
PHOTOS: GETTY IMAGES/ISTOCKPHOT­O Perturbati­on-based balance training can help older adults retain their balance, which declines as we age.
 ??  ?? Exercises that focus on balance — like this one, using a Bosu ball — can prevent falls in those who are over age 65 or suffer from certain diseases.
Exercises that focus on balance — like this one, using a Bosu ball — can prevent falls in those who are over age 65 or suffer from certain diseases.

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