So what IS balance?
In mechanics, balance is used interchangeably with equilibrium. An object is balanced when all the forces acting upon it (i.e. gravity, or movements) result in a static position. This is possible if the base of support is large enough that it encompasses the center of gravity of the object, creating stability.
This equilibrium can also be applied to dynamic stability, in an object that accommodates movements and changes in force, to maintain a stable position; think about a car driving forwards, the center of gravity is always within the base of support.
OK, so how about human balance?
There are three systems that have to work together to be able to accomplish these three activities: The visual system, vestibular system and the somatosensory system. Each of these systems can be trained and improved through specific exercises.
"I'm clumsy because I have bad reflexes"
A reflex an involuntary response to a stimulus, usually in attempt to protect the body from harm. Examples of true reflexes are sneezing, blinking, and the withdrawal reflex. These reflexes occur when a stimulus enters the spinal cord and triggers a response to motor neurons without going to the brain.
There are some reflexes that contribute to balance, known as primitive and postural reflexes. Primitive reflexes are present in infants and help with things like flailing arms to prevent falling, and the 'swim' reflex when put in water. These are usually replaced by postural reflexes within the first year.
Postural reflexes are fed by sensors in muscles and tendons that provide information about length and tension. The most clear example of this type of reflex is the knee jerk: When the tendon is suddenly lengthen with the hammer hit, the quad muscle contracts to shorten, and protect itself.
A true reflex is not something that can be trained; what you have is what you have (according to current research, so that could change!). People typically have 'good' reflexes unless they are suffering from a neurological condition or an upper motor lesion.
Most of the time when people refer to poor reflexes, they are actually referring to reaction time, which can be trained. This refers to things like being able to catch a ball when you don't know when it's coming, responding to external stimulus like a green traffic light quickly, or being able to adjust your positioning to avoid a slip or a fall.
The visual system works for balance by using central vision (object motion perception), retinal slip (perception of movement and personal displacement), and peripheral vision (maintaining quiet stance with no sway).
A person can be assessed for visual deficiencies that may be contributing to poor balance through a series of eye challenges. These include the ability to fixate on a stable object, to track between objects, follow a moving object, and to spot a peripheral object.
If there are deficits, there are dozens of activities that your Athletic Therapist can recommend to improve abilities! These improvements can assist with performance as well, especially for individuals that have to maintain a stable stance, or need to respond quickly to external stimulus like a ball or puck.
The vestibular system is contained within the inner ear, and helps to determine the position of the head, and therefore the body, in the three spacial plains. A complex combination of tubes and fluid allows for tiny sensors to determine tilt, roll and spin of both a stable body and a moving body to determine position. This helps us to stay upright instead of listing to the side.
Deficiency in the vestibular system can also contribute to other conditions such as vertigo, although there are many other complexities there that need to be addressed.
The vestibular system can be assessed through a series of head re-positioning tests, to see if a patient is able to find equilibrium without the assistance of the other systems (somatosensory or visual). Through a series of sessions, vestibular system can be able to learn better how to find center and therefor assist balance.
Many athletes and professionals undergo vestibular training, the most recognizable of which may be the "astronaut protocol" which puts stresses on the system through spinning, turning and inversions, and then requires that tasks be performed until orientation is regained more and more quickly.
The vestibular system is complex and takes input from other systems such as auditory, visual, somatosensory and even things like smell to process information about position. This means that training it must be multifaceted as well, and can be highly effective in improving balance.
You may have already heard of somatosensory training referred to as proprioception. These two terms are used to describe the sensory input from the muscles, tendons, ligaments and skin to help the body to determine joint movement and position. This information is very important when moving around on uneven terrain an responding to changes.
There are many different receptors that work together including muscle spindles, golgi tendon organs, and mechanoreceptors that provide the nervous system with information. This information is processed to influence which voluntary movements (either conscious or subconscious) are executed.
This system is arguably the easiest to assess and train, and is incorporated into every rehabilitation program for musculoskeletal injuries.
Assessments can be targeted at the entire body in various positions (for example maintaining seated posture with eyes closed) or can be targeted at one joint (such as shoulder re-positioning tests). With respect to balance and stability, tests can include standing on one foot, responding to spontaneous pushes from various directions, or standing on differently angled surfaces.
Training protocols are developed to be very specific to the goals of the athlete or individual. These aims can be anything from walking unassisted on uneven snow to being able to accurately pass a basketball while pivoting on one foot.
How do I get started on training?
Begin holding onto something like the kitchen counter or back of a chair, slowly lift one leg off the ground and maintain balance without tipping at the hip. If this is too difficult to start, keep just the tip of your toe toughing the ground. Try to work up to 30 seconds with no support. This trains the mechanoreceptors in your stabilizing foot, knee and hip.
Progressions of this activity can be to close your eyes (training the vestibular system), or to change the point that your eyes are fixated on every few seconds (training the visual system).
Once an assessment has been made, your AT should be able to give you a home program of balance exercises to work on with equipment you already have! These exercises will be specific to your goals, sport, activity, work and hobbies!