Balance in Sports and Physical Activity: Insights from the Innersight Podcast #08 (Part 2)

Balance is a fundamental aspect of our daily lives, whether we are walking, running, dancing, or even just standing. It is a complex process involving various systems of the body, including the sensory system, central processing, and motor output. Understanding how balance works can help us improve it and avoid falls and injuries. In this blog post, we will explore the different aspects of balance, how it works, and how we can enhance it through training.

The Three Steps of Balance

The process of balance involves three primary steps. The first step is sensory input where we receive information about our environment. The sensory input is then processed centrally, and finally, the brain decides on the output or the action to take in response to the sensory input. This complex process involves multiple systems and organs in the body, making balance a challenging aspect to train.

The Role of Proprioception in Balance

Proprioception, or the sense of self-movement and body position, plays a significant role in balance. When we stand on one leg, for example, most of our weight is above our hips, making the body top-heavy. Despite this, we can maintain balance on a small foot surface area, thanks to the incredible circuitry of the input-output process in the body controlled by proprioception. This process happens subconsciously and constantly, illustrating the remarkable efficiency of the human body.

Visual Input and Balance

The visual system also plays a crucial role in maintaining balance. The brain processes visual input in about 100 milliseconds, which helps us correct our balance. For instance, when our eyes are open, we can see and know that we are not falling. However, when our eyes are closed, the brain relies on proprioceptive information to maintain balance. The brain takes information from the ligaments and muscles in the ankle and bottom of the foot and responds accordingly.

Balance in Sports and Physical Activity

The role of balance extends beyond just standing or walking; it is also crucial in sports and physical activities. For example, in rugby, an agile player relies heavily on proprioception rather than sight to stabilize while changing direction quickly. The brain needs to know what the knee is doing at that split second and respond accordingly to prevent injury.

Improving Balance

Falling or tripping does not just happen to the elderly; it can happen to anyone if their proprioception pathway isn't well-developed. Therefore, it is crucial to train and improve our balance. One way to do this is by regularly performing balance tests. For instance, you can try to push a block away from you on a slippery floor while standing on one leg. Repeat this after a few weeks and see if your distance improves. This test can help your brain learn to incorporate the sensation of standing on one leg, thereby improving balance.

In the emergency room, we often see the downside of poor balance, especially in older adults. Whether it's someone who steps off a curb and misses it or someone who stumbles on a step and falls, the consequences can be severe. Falls often result in injuries like broken hips, and the mortality and mobility that follow can be debilitating. The brain learns and trusts itself to maintain balance, but after a fall, this trust is shattered. This can lead to a fear of falling again, which can further discourage physical activity and, in turn, worsen balance.

A study conducted here in the Western Cape sought to explore potential reasons and preventative measures for falls. The study found that 26% of participants aged 65 and older had experienced at least one fall, and 11% had fallen more than once. This highlights the prevalence of falls and the importance of maintaining good balance as we age.

Interestingly, we also see balance issues in younger individuals. So, it's crucial that we start working on improving our balance at an earlier stage than we might think. This is often a neglected area of our health, but it's incredibly important. There is a degree of 'trickle down' with balance as we age. While not entirely sure what the exact rate is, the decline in neuromuscular control, which encompasses the entire balance process, is evident. As we age, muscle strength regresses, reducing the muscles' stabilizing output. Additionally, the nervous system also declines, affecting the body's ability to maintain balance.

However, it's not all doom and gloom. The good news is that balance can be improved, even in our 60s and 70s. Strength training, which includes a stability component, can lead to significant improvements. The key is to start early and maintain a regular routine of balance-enhancing exercises to build up a reserve of balance control that can be drawn upon as we age.

It's important to note that strength and balance should go hand in hand. For example, a young athlete with good balance can generate more power and perform better in their sport. Similarly, an older adult with good balance can be more active and enjoy a higher quality of life.

As we age, we are bound to lose some muscle and sensation, which can affect our balance. However, by working hard when we're younger to build up our balance reserves, we can maintain our balance longer and enjoy the benefits of a more active, mobile lifestyle in our later years. Interestingly, a study found a correlation between walking speed and age. Walking speed can serve as a proxy for numerous factors, including strength and stability. The act of walking requires us to balance on one leg for around 600 milliseconds, under two to three times our body weight in impact forces. If our balance is good, our walking speed increases, enabling us to walk more and sustain a better VO2 Max. In turn, this leads to improved overall health, not to mention the psychological benefits that come with being more active and self-sufficient.

The human body is designed for movement, and endurance is one of our superpowers. However, with the modern lifestyle, we've lost the opportunity to move as much as we would naturally do. For example, we drive everywhere and most of our work is done at a workstation. This rapid change has happened within just two generations, leaving us with much less opportunity for physical activity.

Exercise provides us with the chance to regain the movement we're designed for. Think about it - if you're working in your garden, you need to be stable and strong to bend over and pick up a plant or a bag. If you've been doing this all your life, you're likely in good condition. But not everyone has this opportunity, which is where exercise comes in. By testing and assessing your physical state, you can determine where you are, where you need to be, and how to get there. Balance and stability are integral to this process. If you pick up someone with a balance issue, you can help them improve it through certain exercises. This is usually the first phase of an exercise program - improving balance and stability. Once these are improved, you can move on to strength training. By practicing good movement and strengthening your body, you can make this a habit.

However, if your balance and stability are poor, you need to work on these first. This is where neuromuscular type of training comes in, where you are put in a situation where your stability is challenged. The goal is not to address a hardware problem (i.e., your muscles are weak), but a software problem - we need your brain to write better algorithms and tell your muscles to coordinate better. Once this is achieved, we can then move on to strength training.

Improving balance and stability is a process. It consists of first updating your software to gain the ability to move well. Then, you strengthen this good movement through strength training, making it a habit. Finally, you apply this improvement functionally, by, for example, trying to walk faster on your usual route. If you see improvements on all three levels, you've succeeded in functionally applying the improvement in balance and stability.

Most problems that people face regarding balance and stability are more proprioceptive rather than vestibular. If a vestibular problem is suspected, it's usually referred to a GP or a physiotherapist. However, most of the time, people already know that this is an issue and have already made some attempts to improve it. In such cases, the focus is not on reaching a certain threshold, but on improving as much as possible given the restrictions. If you have a hardware problem like early Parkinson's or MS, you can still train and have a little software update. In most cases, the main goal is to prevent regression. For example, in elderly individuals or those where balance is compromised because of a pathology, a functional test like the Berg balance scale is used. This test consists of a series of tasks, including sitting and standing, and standing with your arms stretched out. The results can then be used to classify the person's stability and make decisions on how to improve it.

Even young people going to the gym need to focus on their balance and stability. Instead of outsourcing the stability responsibility to the gym machines, they should try free weights and exercises that challenge their stability. By knowing your numbers and focusing on all the components, such as muscle power, coordination, balance, and fitness, you can improve your overall physical health and well-being.

Ultimately, the goal is for people to be able to carry out everyday tasks, like carrying groceries up a set of stairs, at any age. This requires proper balance, muscle power, cardiovascular fitness – it's all interconnected. By knowing your numbers and working on improving them, you can achieve a higher level of physical health and well-being.

In conclusion, balance is a critical aspect of our health that often gets overlooked. By prioritizing it from a young age and maintaining a regular routine of balance-enhancing exercises, we can stay active, mobile, and independent well into our later years.