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Perfecting Your Balance

According to an article in the Washington Post, "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. Whether your goal is to age in place or enhance your performance, perturbation training can help."


"The practice gets its name from a lesser-known definition of perturbation: “A deviation of a system, moving object, or process from its regular or normal state or path, caused by an outside influence.” The goal of perturbation-based balance training (PBT) is to use drills and exercises to fine-tune your body’s reaction to anything that might disturb your balance — whether it’s the result of sports, aging or conditions such as a stroke.


How those disturbances are generated during training varies widely, depending on your age, fitness and health status; the actions could involve standing on an unstable surface, for example, or even being pushed. But if you start to fall, you’re doing it right. In fact, you should start to fall about 30 percent of the time per PBT session, says physical therapist Kevin Wilk, associate clinical director at Champion Sports Medicine in Birmingham, Ala., and adjunct assistant professor of physical therapy at Marquette University. “That’s what’s going to produce better motor control changes.”


By experiencing situations where they start to fall and then catch themselves, people can improve their motor control and help minimize their likelihood of falling when they lose their balance in real life, whether on the stairs or the playing field."


Eat This Not That states "The goal is to train your body to get better at catching itself from falls by forcing yourself to actually react to falling."


The Washington Post article goes on to state "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, which s part of Canada’s University Health Network, and an associate professor in the physical therapy department at the University of Toronto. That’s why PBT training is also known as reactive balance training. (It’s also called perturbation-based gait training.)



Challenges differ based on fitness levels. For recreational athletes, PBT could involve standing on one leg for 30 seconds with their eyes closed. Elite athletes, however, might do the same and have no problem maintaining their balance; in this case, they might need to move to an unstable surface, such as a Bosu ball, and stand on one leg and catch or kick a ball to test their reactive balance.


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.


A more low-tech option for high-risk or neurologically compromised older adults would be to perform “mini-squats” with their hands on a sturdy table, Wilk [physical therapist Kevin Wilk, associate clinical director at Champion Sports Medicine in Birmingham, Ala] 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 to match a variety of ability levels, 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.


According to Wilk, “the airplane” is a classic move with variations to meet different ability levels. Stand on one leg with a slight bend in your knee. With your arms outstretched, hinge forward from your hips. When your back is almost parallel to the floor, extend your arms out to your sides and twist your trunk in either direction, as if you’re “landing the plane.”


If that move alone doesn’t challenge your balance, try it while closing your eyes, wearing goggles coated in Vaseline to distort your vision, standing on a piece of foam, wearing a backpack, holding dumbbells, standing on a Bosu ball and/or using a wobble board. If it’s still too easy, don’t be surprised if your trainer or physical therapist gives you an unexpected push."


"The optimal frequency and duration of your sessions depend on your goals. For those at risk of falling, two to three closely monitored one-hour physical therapy sessions per week is ideal, Mansfield says. One study found that stroke patients who did this for as little as six weeks experienced sustained benefits one year later. 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.


A key part of safe PBT training is finding the right guidance. Make sure your fitness professional or physical therapist has the bandwidth to focus solely on you during your session. “It’s very interactive,” Wilk says. “They need to be really watching you to create the ‘just right’ adaptive challenge.” Although there is no formal certification for perturbation training, Wilk notes that there are graduate programs that focus on motor control.


The guiding principle behind perturbation-based balance training is simple, Wilk says: “A little bit of failure is okay.” That’s not bad life advice, either.""

For further tips see my blog post Improving Your Balance to Prevent Falls.


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