A couple of weeks ago I stepped on the rocker balance board in the corner of my office to test my balance with my eyes closed. I failed miserably. I have been slacking off in doing my balance exercises. We will blame the Covid-19 lock-down since it seems to be a good excuse for all sorts of things. Clearly, with a lock-down happening, I can’t be expected to stand on one foot with my eyes closed. Previously, I had been able to balance on that rocker board quite well. Well, I am always telling patients that the balance system is just like muscles – use it or lose it. If you are stuck in bed (or on the couch watching TV), within two weeks you lose half the function of your balance nerves.
Since that test, I have been practicing what I preach. But I have been discovering that simply doing what I have been showing to patients is woefully inadequate. I tell them to find a doorway or countertop and simply close their eyes and try to balance on one foot, using the wall or counter to catch themselves as they start to fall. This did not seem like a big deal back when my balance was good, but now all of a sudden it is not so easy. Without the normal activities that keep my balance in shape, I find that the muscle strength in my feet for balance is lost. Just staying on one foot for more than a few seconds is very unstable. I am having to back up and start with strength training for my feet. I have never before thought of that as a possible issue for patients. Consequently, I have been designing a full spectrum balance rehabilitation program that starts from the most basic “I have no balance at all” level. I do start with the assumption that you can stand up because if you can’t there are larger issues than balance that need to be addressed first.
Last week I had a patient who could walk just fine as long as she was holding onto a walker. If she took her hands off the walker, she felt unsteady and had a fear of falling. The balance and coordination nerves in her hips, legs, and feet were not telling her brain where she was positionally. She had come to rely on the nerves in her hands to tell her where she was relative to the ground. If she held my hands, she could walk forward to the adjusting table, but she could not do this without her hands holding onto something for balance. This had nothing to do with dizziness, ear, or eye issues. Even standing still was a challenge if she closed her eyes. This is someone who has to start at square one with balance training.
Square 1:
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Stand with your feet shoulder-width apart and close your eyes. Once you can do this comfortably for 15 seconds, work through the more challenging balancing techniques below.
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Eyes closed. Do a slow-motion squat with your feet shoulder-width apart
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Eyes open. Stand with your feet completely together for 15 seconds.
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Eyes closed. Stand with your feet completely together for 15 seconds.
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Eyes closed and feet together. Do a slow-motion squat.
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Eyes open. Stand on a balance pad for 15 seconds with feet together.
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Eyes open. Stand with your feet together and one foot 6 inches ahead of the other for 15 seconds. Do both sides.
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Eyes closed. Stand with your feet together and one foot 6 inches ahead of the other for 15 seconds. Do both sides.
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Eyes closed. Stand with your feet together and place one foot 6 inches ahead of the other and do a slow squat. Do both sides.
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Eyes closed. Stand on a balance pad for 15 seconds.
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Eyes open. Stand straight heel to toe for 15 seconds. Do both sides.
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Eyes closed. Stand straight heel to toe for 15 seconds. Do both sides.
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Eyes open. Stand on one foot for 15 seconds. Do both sides
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Eyes open. Stand on one foot on a balance pad for 15 seconds. Do both sides.
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Eyes closed. Stand on one foot for 15 seconds. Do both sides.
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Eyes closed. Stand on one foot on a balance pad for 15 seconds. Do both sides.
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Eyes closed. Stand on one foot on a rocker board for 15 seconds. Do both sides.
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Eyes closed. Stand on one foot on a wobble board for 15 seconds. Do both sides.