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.”
HOW PBT WORKS
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.
WHO CAN BENEFIT
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.
WHAT TO EXPECT DURING A SESSION
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.
FINDING A PROFESSIONAL
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.