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Episode 33: Weebles Wobble But They Don’t Fall Down
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Welcome to Episode 33 of the Movement Logic podcast! Today, Sarah is flying solo - good thing she’s spent a lot of time working on her balance. We tend to think of balance as a precision activity to strive for, but in this episode, Sarah flips the script and shows you why balance is a non-falling event.
You will learn:
- The 3 systems in the body that contribute to balance
- The difference between static and dynamic balance, and which is more important
- What types of exercise improve functional balance, and which don’t (you might be surprised)
- The real reason older clients are afraid of falling
- How to challenge the 3 balance systems for your clients and students in a fun and playful way
- Why Sarah is obstacle course obsessed!
Balance System Challenge Table
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Transcript
Introduction to Movement Logic Podcast
00:00:00
Speaker
Successful balance doesn't mean that you never lose your balance. Losing and then recovering your balance is a successful, not falling, event.
00:00:12
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
Solo Hosting by Dr. Sarah Court
00:00:47
Speaker
Welcome to episode 33 of the Movement Logic podcast. I'm Dr. Sarah Court, physical therapist, and today it's just you and me. We're gonna let Laurel have a day off, which if I know Laurel, and I think I do, I mean, she's probably creating some cool new kettlebell flow or movement variation in her basement right now, or maybe she's on a hike and making sure she's not stepping on a snake. Nobody wants to step on a snake.
00:01:14
Speaker
Before we get into today's episode, I have a quick favor to
Encouragement for Podcast Ratings
00:01:18
Speaker
ask you. Could you rate us five stars? It's really easy. You just go on Apple Podcasts or Spotify or wherever you listen and you just click that fifth star and they all light up and it's very satisfying. One person gave us a four star review and
00:01:33
Speaker
If Laurel's listening to this, she's gonna be laughing right now because she knows that it really irritated me for no good reason, really. I mean, I guess the person felt like we weren't quite a five-star podcast and, you know, perhaps they're not even listening anymore, but if they are, maybe they could go in and like just add that extra star to their rating. But what I would really like is if more people gave us five stars, then eventually that one little crappy four-star review won't even show up in the math and it'll look like five stars again.
00:02:02
Speaker
Does it mean really that much to me? Apparently. Should it? Probably not. But I would love it. If you haven't done it already, that would be really awesome.
Understanding Balance Systems
00:02:12
Speaker
Today's episode is all about balance. What systems in your body are in charge of your balance? The two types of balance, so that's static or dynamic.
00:02:22
Speaker
strategies for not falling, which is not the same thing as losing your balance, what movement practices actually improve your balance and which ones don't, you might be surprised. And why balance becomes such a concern for us as we get older, especially women, and then specific ways that you and your students or clients can effectively work on improving your inherent balance skills.
00:02:47
Speaker
Let's start by talking about the three systems in your body that are in charge of helping you balance. These are the vestibular system, your vision, and proprioception. We're going to get a little bit into each one, but the big takeaway is that if we have decreased acuity in any of them, if we are starting to lose our sight, if we have something going on in our inner ear, if we just never really worked on our proprioceptive skills,
00:03:15
Speaker
it's going to impair our ability to balance and we may end up having to learn how to rely more on the other two systems. The first system is your vestibular system, which is your inner ear. In PT school, we had a whole chunk of learning about vestibular disorders and there are PT clinics that actually specialize in vestibular disorders. But I have a bit of a mental block around it because
00:03:41
Speaker
We had a guest lecturer come in to teach this section. At one point, he had me come up to the front of the class and demonstrate something, which is the kind of thing we did all the time. Then as I was doing it, he insisted that I was doing it backwards, that I was doing it in reverse. I was pretty sure that I wasn't.
00:03:59
Speaker
And I was looking at my classmates and they were looking at me like, I think you're doing it right. And then he was like, respect my authority. And he made me do it. He made me do it backwards. And ever since then, I've been very gun shy around vestibular disorders because I somehow don't trust that I understand it. And welcome back to Sarah's therapy corner. The point I am taking way too long to make is that the vestibular system isn't as complicated as you or I might think.
00:04:24
Speaker
And also, as teachers, let's maybe all take a moment when we are confronted with the possibility that we may have misspoken and make room for the student to actually be right.
00:04:35
Speaker
Okay so your inner ear has some different structures. Some of the structures in your inner ear like your cochlea are for hearing and then there's some other structures that are for balance and the way that the structures that are for balance work is they send information to your brain about where you are in space or if you're moving how your head is moving through space and if that information
00:04:58
Speaker
matches what your vision is telling you, then your brain is like, cool, got it, I know where I am. So the problems come in when your inner ear has some kind of disorder. And what happens then is the inner ear information contradicts the visual information.
Exploring Vestibular Disorders
00:05:13
Speaker
And then your brain gets super confused and you get things like vertigo and spinning and nausea and all kinds of stuff like that, which if you've ever had it, and I have, it totally sucks.
00:05:24
Speaker
So let's talk a little bit more about these structures of the inner ear that are for balance. There's two that are in charge of sensing where your head is positioned, and they're called the utricle and the sacule. And they also tell your brain whether or not your head is tilted, forwards or backwards or to one side or something like that. And they contain these little stones, little crystals that are called otoliths, or sometimes they're referred to as canoliths. It's the same thing. I don't know why it has more than one name.
00:05:53
Speaker
And the otoliths are held in this kind of viscous fluid. And then there are these little sensors. You can think of them almost, it's almost like they are the seaweed waving in the ocean. They're called hair cells. And when you move around or you tilt your head, the otoliths move across these hair cells. And then these cells then report your position of your head to your brain. That's really cool, I think. And then the other structures
00:06:22
Speaker
are called the semicircular canals. And they are in charge of reporting the direction of movement that your head is moving in. They also contain fluid and hair cells, but they don't have any otoliths. They don't have any of the little crystals. It's just the fluid moving over the hair cells that tells your brain where and how your head is moving through space. And the semicircular canals are exactly what they sound like.
00:06:49
Speaker
canals that are partly circles, but they each are on a slightly different angle, so they each are reporting slightly different pieces of information to your brain when you're moving. The problems start happening when the otoliths and the fluid and the hair cells get all messed up and they interfere with each other, and they actually start to send misinformation to your brain. One of the most common ways that this happens is something called BPPV,
00:07:18
Speaker
which stands for benign paroxysmal positional vertigo. I take issue with the fact that it's called benign because I've had it and it truly feels terrible and not benign at all. What happens with BPPV is the otoliths, which, as you remember, are supposed to stay in the utricle, right? They escape and they go into the semicircular canals, which is not where they're supposed to be.
00:07:41
Speaker
And then your brain is like, are we moving or are we staying still? I cannot tell what is happening, right? Because the information about moving and getting and staying still is totally muddled. And so what it feels like then is that the world is spinning when you are holding still.
00:07:58
Speaker
And depending on how bad the symptoms are and where exactly the otoliths have traveled, it can happen in all kinds of different positions. Or for example, you turn over in bed, and 30 seconds later, when you're not moving anymore, the whole world suddenly spins around you. If you've ever been horribly drunk and or hungover, I mean, no judgments. But if you've ever had either of those situations so badly that you have the spins, it's like that, but worse, basically. When I had it,
00:08:28
Speaker
This is one of the things where I was like, I feel terrible about this. But when I had it, the way that I discovered that I had it was I called my dog over to me and she came trotting over, wagging her tail. And when I leaned down to pet her, the entire world did a full on just like tilt a whirl. And I thought I was going to fall on my face and I yelled fuck really loudly right in her face. So from her perspective, I called her over and then for no reason I screamed right in her ear. Sorry, Pearl.
00:08:58
Speaker
So the good news about BPVV is that it is totally fixable. There's a series of tests to determine which of the semicircular canals is the one that's got the little stones in it. And then you do something called Epley's maneuver, where you go through a series of positions that is designed to get the otoliths back into the utricle where they belong. It's kind of like those games, you know, when there's like a small wooden board.
00:09:22
Speaker
And then there's like a series of different holes and walls and there's a little silver ball and you're tilting the game around to try to like not have the ball fall into the wrong hole and go around the corner and then around this corner. It's basically that premise happening inside your ear. And it actually really works. You may have to do it a few times in a row. It may take a little while to resolve completely, but it actually really works. The bad news is that once it happens, it's more likely to happen again.
00:09:50
Speaker
But at that point, hopefully you've learned the Epley maneuver and you can sort of self-correct before having to go into the CAA specialist. So that's BPPV, which is in the sort of like, it sucks, but it's fixable category. There are other inner ear disorders like labyrinthitis and vestibular neuritis, which are inflammatory conditions that also make the world spin and can also cause ringing in the ears.
00:10:16
Speaker
It's not clear what the source is for these. It may be bacterial. It may be viral. It tends to resolve. It tends to clear up in a few weeks.
00:10:26
Speaker
There is one condition that I'm going to talk about briefly that is really debilitating and it's called Meniere's disease because it is a total failure of the inner ear system. So you have vertigo, you have ringing, you have hearing loss. Because it's a total organ failure, your nervous system is tripped by it. And so you have an automatic, excuse me, autonomic nervous system response, which means then you could also have nausea, vomiting, sweating.
00:10:55
Speaker
And the worst part of it is there's no known cure. So you have to kind of figure out how to live with it. There's medication, there's physical therapy, diet can help, but nothing fully resolves it. So if there's one to not get, it's that one. Okay, so that was kind of a deep dive down into your inner ear, the workings of your inner
Vision and Proprioception in Balance
00:11:14
Speaker
ear. Now let's talk about our vision. And our vision gives us almost instantaneous information about where we are in space. Now, I'm not gonna go into like massive detail about the workings of the human eye.
00:11:24
Speaker
i don't think i need to but i think we all understand that if we have had visual acuity our whole lives and then we start to lose it whether it's you know night blindness which is not actual blindness it just means it's hard for your eyes to adjust to low light conditions or things like macular degeneration or cataracts
00:11:45
Speaker
You know, if we've been really heavily reliant on our visual system, then it starts to get taken away from us. That can really, really impair our balance, right? Because most, most of us rely on our vision for absolutely everything and balance is a big part of it.
00:12:02
Speaker
The other thing that I wanted to point out about vision, I remember learning this and thinking, this is so cool. So our eyes always want to be level with the horizon as sort of like a neutral point for our brain. Right. So let's say you have a new musculoskeletal imbalance. You've got a like pain in your back on one side and it's making you kind of lean over to the other side.
00:12:24
Speaker
to kind of get away from the pain or something, or you have like a scoliosis or a hip hike or something that's tipping your body over, your body will sort of adjust. It'll even itself back out above the imbalance to ensure that your eyes are horizontal. So that might means you would then have to, like if right now, if you're sitting listening to this, if you lean your body over to the right, and now you realize, okay, well, my head is also leaning over to the right.
00:12:50
Speaker
For my eyes to be on the horizon, I now have to tilt my head to the left to make it straight. And now I've got this like hiked up shoulder in my ear, right? So now you are potentially giving yourself an additional set of problems just because your eyes really, really want to be level. They're not interested in living in a tilted position.
00:13:10
Speaker
Okay, so the last system is our proprioception, which most movement people I think are somewhat familiar with, but if you're not familiar, proprioceptors, the word roughly means receptors for self, which I think is kind of cool. And it's our brain's ability to know and potentially to a really great deal
00:13:29
Speaker
of specificity where our body is in space at any given time without having to look with our eyes sometimes it's called kinesthesia or people sometimes people refer to themselves as kinesthetic learners meaning they they learn
00:13:44
Speaker
movement through the feeling of it in their body better than watching a demonstration or receiving a verbal cue, right? So that's another thing to think about when you're cueing. And if you haven't yet, you should absolutely go listening to our episodes on cueing. And there's going to be another one after this episode as well.
00:14:03
Speaker
So proprioceptors are these specialized mechanoreceptors, or these specialized nerve cells, and they're distributed throughout your body, all over the place in muscles, tendons, skin, joints, but they are especially concentrated in the joints of the ankle.
00:14:19
Speaker
which makes a lot of sense if you think about it because as you are standing, walking, jumping, hopping, running, skipping, any other uprighting activity, your foot's relationship to the ground is going to be the first source of information about
00:14:35
Speaker
where you are in space, whether the ground is flat or angled, soft or hard, moving or still, and that information needs to get transmitted ASAP to the spinal cord in the brain so that the body can respond in whatever way it needs to in order to stay upright and not fall over. Because of that, there's other medical conditions that can impact your balance that you might not automatically think of,
00:15:00
Speaker
So, for example, diabetes can impair sensation on the soles of the feet, which makes it much harder for people to balance when they're moving or they're walking and be more susceptible to falling.
00:15:12
Speaker
Okay, so we've covered our three systems in our body that are in charge of balance, right? The vision, vestibular system, and your proprioception.
Static vs Dynamic Balance
00:15:22
Speaker
So now what I'd like to talk about are the two basic types of balancing that we deal with, and that is static balance and dynamic balance.
00:15:31
Speaker
Static balance, as you probably already know or you may be able to figure out from what it's called, is the ability to balance while you're holding still. But I think the confusion can arise here because we get the idea sometimes that maintaining static balance means we don't move at all, but that's not the case. If you're listening to this and you can stand up or you're not driving or if you're walking or whatever, just pause for a second, stand on one leg.
00:15:59
Speaker
And when you do that, you'll feel that your ankle is wobbling around and quite possibly your hips are moving around. And depending on how challenging this is for you, you might be waving your arms around. So these movements are still under the heading of static balance because you are trying to stay still.
00:16:17
Speaker
and your body is responding to this directive by making these positional changes as it needs to, right? So this is not just because you are wobbling, doesn't mean you're not practicing dynamic balance. You're attempting to practice static balance, but within static balance, there's quite often a fair amount of weeble wobble.
00:16:37
Speaker
So then dynamic balance is your ability to balance while you are moving through space. And the most common dynamic balance and the one that most of us take completely for granted is walking. While you're walking, there's always a moment where you only have one leg on the ground. But dynamic balance is any type of movement where you want to maintain your balance while you're moving. Like if you are standing still on your feet, but reaching forward for something.
00:17:04
Speaker
and and taking your body you know off of your center of mass or you know let's say you were standing on one leg and you're moving to stick a toe in your swimming pool to feel the temperature without falling in or you're in a yoga class you're going from let's say half moon pose and you're transitioning back to warrior two and so you've got that hinging moment happening around that front leg before you put your back leg down right these are dynamic movements and then
00:17:28
Speaker
You know, it's rare to be doing just one or just the other. We often move in ways that are combining these different types of balance, meaning you might be going from static to dynamic or dynamic to static or just kind of alternating between the two. So, for example, static to dynamic might be a sprinter at the start of a race in that crouched position.
00:17:50
Speaker
They're balancing on basically like their toes and their fingers and then the gun goes off and then they start to run and running is a dynamic balance activity.
00:17:59
Speaker
Dynamic to static might mean if you think of a gymnast doing a series of tumbles across the floor and then they stick the landing. Alternating between the two might be like a kettlebell flow where you have moments of pause. Let's say you're going into a one-legged queen and you're trying to hold your balance there and then you flow through a swing and you do it on the other side.
00:18:20
Speaker
or in a yoga class you might be transitioning between one balance pose to another balance pose like from a crow pose into a headstand right so that's static dynamic static so many lists today my god we've got the three systems of the body that are in charge of balance right vestibular vision proprioception
00:18:39
Speaker
And we've talked about the two different types of balance, static and dynamic. And also how quite often when we're moving through our lives, we're not thinking like now I'm static, now I'm dynamic. We're just kind of moving back and forth between the two. Also now, speaking of lists, I have another list for you.
Balance Recovery Strategies
00:18:53
Speaker
So these are something that I learned in PT school as balance strategies, but I like to think of them as anti-fall strategies.
00:19:02
Speaker
Because it's the three things that you will do without even thinking about it to try and regain your balance when you are losing it. These are automatic responses. You will understand this list intuitively and probably just never thought of it as a list before. So the first anti-fall strategy or balancing strategy is the ankle strategy. This is the part where your ankle wobbles around to keep you steady. So if you've ever been in a yoga class and
00:19:27
Speaker
you're doing tree pose and you can feel that your ankle is like wobbling wobbling wobbling that's just what it's doing right all those proprioceptors are giving information to your brain and your spinal cord about where you are in space and you're making adjustments you're not directing your ankle what to do right it's just this automatic thing where your ankle is moving so that's your ankle strategy now
00:19:48
Speaker
If standing on one leg in tree pose or any other pose is not something that you do very often or it's not something that you have made your legs strong enough to be able to support you in, the ankle strategy is not going to be enough. You will start by with your ankle wobbling, but pretty quickly you're going to jump to the next strategy, which is called the hip strategy. And so by this point, you're no longer making just these small, tiny little shifts at your ankle.
00:20:14
Speaker
you're moving your hips around and your hips are going through a larger, a much larger excursion than your ankle, right? They're going way off center. They're going all over the place. This is, you might even get your arms into it. So you're waving your arms around, you're kind of jerking your hips from side to side or front to back. You're working really hard not to fall over. And so then finally, sometimes you can catch yourself with that hip strategy if you've tried it before, right? But so if the ankle strategy and the hip strategy have both failed
00:20:43
Speaker
and you find yourself in the act of falling, your third strategy is called a step strategy and that's when you put your other foot down on the ground in order to not fall over. So do you see what I mean about how you knew this intuitively but maybe never thought about it or categorized it or made a list of it so specifically before?
00:21:02
Speaker
And so if someone falls down, it means all three of these strategies have failed, which might be inevitable if something happened like you tripped over a tree root that you didn't see and you didn't have time to get your other foot down fast enough, right? And you just fall down.
00:21:18
Speaker
I want to talk a little bit about what does it actually mean to lose your balance. A big point that I make often when I'm working with people is that successfully balancing is not this idea of somebody holding their warrior three and just absolutely stuck still in space. That's a physical feat.
00:21:40
Speaker
That's something that people might practice and work on and get better at. Yes, that is a static balancing position. But if you're working with someone and typically it's someone who is in the older population and they're interested in making sure that they have good balance, one of the things that I regularly remind people is that successful balance doesn't mean that you never lose your balance. Losing and then recovering your balance is a successful not falling event.
00:22:09
Speaker
Falling means you were not able to access any of your balance strategies for some reason, and that might be your reaction times, it might be your strength, it might be your range of motion at a particular joint, it might be your motor control, meaning the right muscles just don't come on at the right time for the job. For example, I step funny off of a curve, my ankle doesn't have the range to handle the unusual position,
00:22:35
Speaker
not a position that creates injury, just an untrained position. My center of mass moves beyond my base of support, meaning I'm caught off center.
00:22:45
Speaker
I don't possess the reaction time to then step with my other leg and catch myself, and then I fall. The event of falling means a whole series of other options that my body ideally can access were not available. Versus, let's say you step funny off that same curve, but you have good enough range of motion in your ankle with strength in that position to handle
00:23:09
Speaker
this sudden change in in where your center of mass is as well as the speed the strength and the speed to step your other foot underneath where your center of mass now is and you recover your balance and you know are there wobbles and funny arm flailing and involved you know absolutely but you didn't fall to the ground and you didn't injure yourself
00:23:31
Speaker
The reason I'm making this point is twofold. If you work on balance with your clients, you may want to reframe what you think of as quote unquote successful balancing to include not just a little bit of ankle wobbling, but the full body herky jerky as well as stepping down with the other foot.
00:23:48
Speaker
I'll have patients sometimes who are working on balance and they'll give themselves a hard time if they do any of these things. And I have to remind them, hey, you didn't fall, right? If you were in your bedroom and it's the middle of the night and you tripped on a corner of the rug when you're on the way to the bathroom, but you caught yourself by reaching out for the dresser, hooray. That's a successful non-falling event. The second part is if you get into reading research around balance and falling,
00:24:13
Speaker
you really want to make sure you know what they are defining as balanced because sometimes they are excluding things. For example, there was this study about 10 years ago that everyone got really excited about because it seemed to find a link between
00:24:26
Speaker
the ability to get up from the floor without using your hands or your knees or whatever, and all cause mortality, which means not from a disease or illness. But when you read the study, it's got a lot of problems, not least of which what they found was that the older you are, the more likely you are to die, which is just true, regardless of how well you get up off the floor.
00:24:51
Speaker
But what I didn't like about it was they took points off if people wobbled or lost their balance but didn't actually fall.
00:24:59
Speaker
And I was like, come on, what the hell? You're asking people to get up from the ground, don't use your hands or your knees, and don't use any of your strategies to not fall over if you happen to get caught off center. This not only is a really big ask, but it's kind of a dick move, in my opinion. So if you are looking at research, make sure you check on what they are calling successful balancing, and especially if it's a static balance test.
00:25:25
Speaker
I don't think it's fair to exclude wobbling or even in some cases using your other leg, right? Balance in the real world is not about this perfect vision of a yogi perfectly aligned and all this kind of stuff. Balance is just not falling.
00:25:43
Speaker
Right? So let's start to reframe balance as as not falling because that's that's really what
Exercise and Balance Enhancement
00:25:49
Speaker
it is. Okay, so I'm all done with my lists. You're probably very glad about that. And even as I said that, I just realized I'm not there's a list coming up later. Oh, anyway, it's a good list. You're gonna you're gonna love this list. Oh my god. Okay, so one of the things that we hear all the time is that yoga is really good for your balance. And it definitely is.
00:26:09
Speaker
But I think a more useful way to understand how to improve your balance is not by the type of activity like yoga or Pilates, but by what type of movement improves balance. And even more importantly, understanding the relative value of improving static balance
00:26:27
Speaker
versus improving dynamic balance. So here's the thing, and this is what has been found in the research. If you work on static balance, like standing on one leg or doing a tree pose and yoga, you will improve your static balance, which is, you know, good news, right? I mean,
00:26:43
Speaker
Yes-ish. If your goals around balance are specifically about, I want to improve how well I can do the balance poses in a yoga class, you will reach those goals. But for people who are worried about their balance in their day-to-day life, static balance is not a super functional thing to improve. In the world of PT, we use a single leg balance to see people's strength differences side to side because we can watch for compensations like leaning way over,
00:27:09
Speaker
or hiking up a hip and those can show us where we need to work on someone's strength or motor control. But that doesn't translate to, oh, you can do that static balance. Great. Now when you walk and there's an uneven patch of sidewalk, you will manage it perfectly. So then you would think, okay, well fine. You're telling me a static pose is not going to help with anything except static balance. So what if I make it unstable? What if I put them on a couch cushion or a foam pad or one of those vibration plates like they have at the gym or
00:27:39
Speaker
even have them be in a stable position, but I play catch with them. Does that improve their dynamic balance?
00:27:48
Speaker
No, it only improves static balance. This is a total aside, but some of the research around balance is, in my opinion, just ironically, unbelievably cruel. You're taking somebody who already has issues with their balance, they're probably afraid of falling, and then you put them on a standing plate that suddenly jerks them around to test how well they deal with something that they're not very good at. I mean, I get it, I guess, but come on, there's gotta be better ways.
00:28:17
Speaker
According to research, the only way to improve gait speed, which is also a measure of confidence in movement and decreased fear of falling, is dynamic balance.
00:28:28
Speaker
This is the functional balance that people need for walking and being able to recover if they misstep and trip without falling. So this means not only working on balancing while moving, but also challenging the visual, vestibular and proprioceptive systems. And I'm going to talk about how to do that in a moment. The bottom line is if you want someone to feel more stable,
00:28:48
Speaker
While they're walking you have to practice walking you may have to do it in a certain parameters and I'm gonna talk a little bit about about what those might look like but It's like any sport, you know people do specific training for you know soccer They'll do special drills or you know as you all probably know by now I'm motorcycle obsessed and there's a very specific kind of a strength you have to have in different parts of your body to hang on you know, probably don't think about walking as a sport, although there's probably
00:29:18
Speaker
like speed walking competitions that stuff is weird anyway we don't think about walking as a sport but it absolutely is ish could be it has really specific requirements to do it without falling and you know if you're not working with the older population you may not be running into a whole lot of people who are concerned about their balance but i tell you like the second you start working with with anyone older they'll bring it up
00:29:47
Speaker
whether they have ever you know I'll have someone tell me you know I'm worried about my balance and I'll say have you ever fallen and they're like no okay well what makes you worry about well I just know that like if I fall it's gonna be really bad you know I'm gonna talk about why people have that belief in a moment and then in terms of what type of exercise is helpful meaning
00:30:09
Speaker
you know, strength training versus yoga versus Pilates versus aerobic exercise versus anaerobic exercise. The bottom line is that any type of exercise is going to help people improve balance more than being completely sedentary. Coupling that exercise with proprioception training, right, which means
00:30:27
Speaker
as we're doing whatever we're doing, we're challenging the proprioceptive system, is the most effective way to improve dynamic balance. That study that I read was really about like, if you do nothing, is it worse than doing something? As with most things, the answer is yes, you should definitely be doing something and something is better than nothing. Strength training in particular has been shown to help people improve their balance and it's not surprising to me because part of it is,
00:30:56
Speaker
Do you have the power in your muscles and your legs and your hips to catch yourself if you trip? When you think about something like a squat, right? Especially if you're doing like an ass to grass squat, you're taking your body through a lot of ranges of motion.
00:31:12
Speaker
at the ankle, at the knee, at the hip, and you're strengthening at those ranges, which is what your body needs if it's going to be able to balance well. It's part of what your body needs, but in terms of our musculoskeletal interventions, strength training is definitely one of the best things you can do for your balance. Sarah, I'm going to totally change the topic here because I have three questions for you.
Yoga for Pain Relief and Balance
00:31:33
Speaker
Why do yoga teachers have so much hip flexor pain? Why
00:31:39
Speaker
are yoga teachers who tend to be quite hypermobile, so tight all the time, and how the heck can all these yoga teachers with yoga butt get rid of their yoga butt, aka proximal hamstring tendinopathy? How does this work? What's the deal?
00:31:55
Speaker
So that's a lot of questions all at the same time and that would be very hard and take up the length of this entire episode for me to answer. So the good news is I'm not going to have to do that. And the reason why I don't have to do that is that we already made a entire tutorial. Five hours. Five hours. Keep it forever. Forever. Review as often as you'd like. As often as you'd like. Five continuing education credits with Yoga Alliance. Those are
00:32:23
Speaker
Important maybe I mean that's up for debate, but anyway. We've done a bunch of tutorials. This is our sixth tutorial and Incredibly it was overwhelmingly our most popular Tutorial when we first launched it last year does this relate to the three questions that I asked you it absolutely does because this tutorial gives really practical
00:32:44
Speaker
answers in the form of movements and exercises to help you understand if these things are happening to you as a practitioner or as a teacher or to your students why they might be happening and what you need to do to help. And it's not only those things. Wait, what were the ones that you said?
00:33:00
Speaker
Well, it was hypermobility, hip flexor pain, and yoga butt. There are more though, right? So many more. We talk about SI joint pain. We talk about tightness, just feeling tight all the time, even if you're not hypermobile. Sciatica! IT band syndrome. All of these things that are very common for teachers and are exceptionally common for our students as well. Yeah, and it's not just the practical exercises that potentially address some of the symptoms that students might be experiencing.
00:33:26
Speaker
that help fill in the strength gaps that might be contributing to the problem. Spoiler alert. There are some strength progressions that include kettlebells and barbells in this tutorial. There is also some exceptional anatomy instruction. Thank you, that was my part. And so we're putting it all together with the science, the theoretical,
00:33:50
Speaker
and the practical to help you actually have more solutions to offer your students and to be of service to your students in a way that speaks really quite directly to a lot of the problems that they are going to probably come to you with as it turns out. So why are we talking about this right now?
00:34:05
Speaker
Because we're having a sale, we've actually discounted this course. You can buy it at a discount, which is less than full price. So we've actually discounted this thing more than 25%, which is probably the best sale we've ever had on a single tutorial, wouldn't you say? Definitely. Yeah. So if you've been wanting this tutorial, if you missed it the first time around, you should
00:34:31
Speaker
snap it up quick because this sale will end, it will go back to full price. So it was around $130, now it's $100. So just in case you don't know, it's me, Sarah, but also Jason Perique, who is a genius and the co-host of the Yoga is Dead podcast, which I highly, highly recommend you check out. So make sure that you click the link in our bio, head on over to the page that tells you all about what's included and snap it up before it's gone.
Aging, Neuromuscular Changes, and Balance
00:35:01
Speaker
So before we talk about strategies to improve our balance that challenge our visual vestibular and proprioceptive systems, I want to go back to what I had mentioned earlier about why balance is something that becomes a greater and greater concern as we get older. From a neuromuscular skeletal perspective, there are changes that take place as we age that will absolutely impact our ability to balance if we don't do anything about it. So first up is our muscle capacity.
00:35:29
Speaker
And to talk about that, we have to get a little bit nerdy and talk about what a motor unit is. So a motor unit is one motor neuron, which is a nerve that is in charge of telling some muscle fibers to contract and then all of the muscle fibers that that motor neuron attaches to.
00:35:46
Speaker
So the whole thing, the motor neuron plus its motor fibers is a motor unit. Well, so what starts to happen is we have fewer motor units and the remaining motor neurons are then in charge of more muscle fibers, which means we lose force and power output as well as precision in our movement.
00:36:07
Speaker
And we also start to lose bone density, particularly for women, and particularly after menopause when our estrogen levels go down. We have an entire bone density episode coming up later in the season, so I'm not going to go into a ton of detail, but decreased bone density means decreased bone strength. So it makes sense that people become very afraid of falling.
00:36:29
Speaker
because a hip fracture comes with a 20% mortality rate. And that's not because of the hip fracture, but because people with a hip fracture go into a hospital and sometimes they don't come back out. So because of this, people are walking around with some fear about falling. So they decrease the variety in their movements. And so this makes them have poor balance because they're not challenging their body in lots of different positions. They're not working on that variability
00:36:59
Speaker
And so then they're more likely to fall. So then they continue to decrease what feel like risky movements. And you'll see people even like kind of shuffle their feet along the ground because that way you don't have that single leg moment in your walking. And that's again, that's something that people will just do without even thinking about it, right? They just sort of start to shuffle their feet because it seems safer than picking a foot up and then picking the other foot up.
00:37:24
Speaker
but so now we've decreased the types of movement we're doing we're not even doing the work of picking our leg up we're getting weaker and it becomes this really gnarly just kind of self-fulfilling prophecy where this more frightened you are of falling the less risky or different or interesting movements you're doing
00:37:42
Speaker
And that just, it's the ouroboros, right? It just feeds on itself. So while it's true that any kind of exercise will help with balance more than just being sedentary, it only stands to reason that working on strength training will not only help improve balance, but as we know, especially if you are lifting heavy, will improve bone density.
00:38:04
Speaker
and as well impact training which is a subset of plyometrics which is another episode coming up this season that will also improve bone density and if you're jumping is a form of dynamic balance so you get to be super duper efficient and improve multiple things at the same time not to mention as well that strength training improves confidence and improved confidence will help offset some of the fear around falling
00:38:28
Speaker
Look, it wouldn't be movement logic if I didn't plug strength training at some point, but this is not an empty plug. It really does make a difference for balance. I don't know what an empty plug is. The frustrating thing, and we've talked about this quite a bit this season, is that so many women are discouraged from lifting heavy for fear that they might hurt themselves.
00:38:47
Speaker
when in fact it is protective against future injury or future falls and can improve bone density so that if they did fall and let's say they weren't able to catch themselves in time the likelihood of an actual fracture goes down. We talk about that quite a bit in our first episode of the season and you'll hear us repeating it because it's just
00:39:07
Speaker
It is a frustration that Laurel and I share that we just feel like enough is enough at this point. You know, it's time to bring out the big guns and start lifting heavy and taking up some space and all of those things that women historically have been told not to do. So we know that yoga, something like yoga, can help improve our static balance. Okay, fine.
00:39:26
Speaker
And to be fair, there are also moments of dynamic balance in yoga, like stepping back from half moon to warrior two. But, you know, if somebody had real balance concerns, that's a pretty advanced maneuver and they may not be able to successfully navigate it. I'm not going to make somebody who tells me they're having a hard time balancing. I'm not going to be like, great, let's go into half, uh, half moon. And then you're going to step back to warrior two, you know?
00:39:51
Speaker
So something like that is good for someone who is maybe not yet concerned about dynamic balance or feel like they're losing it or not strong enough and they're able to work on it because they have the range of motion and they have the strength for that movement. How do we then in a sort of like quote unquote real world setting
00:40:09
Speaker
work on dynamic balance while also challenging the vestibular visual and proprioceptive systems, right? We want to make all of them as functional as possible and make it so that we're not quite so constantly reliant on our visual system for all information about balance.
00:40:27
Speaker
There's a pretty straightforward formula to use that I'm going to share with you.
Challenging Balance Through Exercises
00:40:32
Speaker
You may want to either get something to write this down with or listen to it again and write it down then. This is something that I learned again in PT school. This was another thing that for whatever reason, it's something about the way that it's presented to me. I'm like, this is way more complicated than it needs to be. It does not need to be this hard.
00:40:53
Speaker
I've redone it in a way that I think is a lot easier to understand. What you're going to do is you've got something to write with and something to write on, not just like your table or the wall. You're going to start by making three columns. The first one is visual, the second one is vestibular, and the third one is proprioception. The way that we challenge each system is by either reducing or completely taking away
00:41:20
Speaker
one of those three systems so that the person has to rely more on the other ones. And there are two different criteria that we are going to use to do this, either keeping your eyes open or closing your eyes and either being on a stable surface like a flat floor versus an unstable surface like a foam pad or a yoga bolster.
00:41:41
Speaker
Eyes closed is obviously going to completely remove the visual system and an unstable surface is going to make it harder for someone to use the proprioceptive system.
00:41:51
Speaker
As far as I know, there's not really any way to completely remove your vestibular system because it works even with your eyes closed, but there's ways to challenge it. So if we're going to start with, let's say I want to challenge the visual system, I want them to actually work on using their vision. This is a bit unusual unless you are working on something specific to their visual acuity, but you would have that person stand on an unstable surface. So underneath visual system, you're going to write unstable surface.
00:42:19
Speaker
And this way, the person has less proprioceptive ability, right? You're making their proprioceptors in the ankles work really, really hard. And so as a result, they have to rely more on their visual and vestibular systems.
00:42:34
Speaker
So since we all tend to be best at using our visual system, if you're working with someone who has a really hard time with balance, maybe they've already fallen a few times, this is probably the best place to start because it's the least challenging criteria. You get to keep your eyes open. You're standing on something probably with two feet to begin with, but the surface is a little wobbly.
00:42:54
Speaker
And you're just wobbling your ankles around and getting used to that, right? You can always make it harder in lots of different ways. So then underneath the column that says vestibular, meaning I want to challenge my vestibular system, you are going to write eyes closed plus unstable surface.
00:43:10
Speaker
So the visual was just unstable surface. Now for the vestibular, we're saying eyes closed plus unstable surface. That means we have completely removed the visual system and we have made it harder for the person to rely on their ankle proprioceptors. So the person is going to have to rely much more heavily on their vestibular system to balance. This is the absolute hardest combination because we have taken away or dialed down two of the three inputs.
00:43:37
Speaker
And then if I want to challenge their proprioception, I have two combination options. I can do eyes open and standing on an unstable surface, which means that I'm getting visual input, but I'm making my ankle proprioceptors work harder.
00:43:54
Speaker
The other combination is eyes closed and a stable surface because I'm removing visual input and then relying much more on my proprioception and my vestibular system. So if this just made you dizzy, pun intended, I will make this little table and put it in the show notes for you. But the basic premise is that you are playing with two different parameters, eyes open or eyes closed, and a stable versus an unstable surface.
00:44:19
Speaker
And you're just going to see what is the most challenging thing for your client to do without actually falling and then you choose those criteria as where you want to start your work. Now, if you're saying to yourself, hang on a second, I thought you said we need to work on dynamic balance to improve dynamic balance and then it doesn't that mean moving and these parameters sound like they are for standing still.
00:44:42
Speaker
Well, I applaud you because you're absolutely right, but we have not yet included the moving part. And one of my absolute favorite, most fun thing to do with clients, the obstacle course. If you have never made an obstacle course out of yoga or gym props before, you are missing out on one of the great joys of life.
00:45:04
Speaker
Not only is it fun to set up challenges and increase the difficulty, it's also fun for your clients to do, and it gets them in a playful place while working on balance.
00:45:14
Speaker
you can do a floor is lava style obstacle course where they can only step on the props and nothing else or a hopscotch or a balance beam or some combination of the three the only limit is your imagination if you know someone is at one leg that's stronger than the other force them to do more of the work with the weaker leg right make them hop around on their weaker leg
00:45:37
Speaker
If you want to see an obstacle course in action, I will find some on YouTube and link to those in our show notes so you can get an idea. So what we add to our obstacle course then are our two parameters of eyes open and eyes closed. And let's clarify, you're not going to make someone go through a crazy complicated course and then ask them to do it with their eyes closed. But maybe you have a section where they are tandem walking, which is heel to toe.
00:46:03
Speaker
and you have them try closing their eyes for that and you are completely nearby or they have something to hold on to if they're too wobbly. And then the other parameter is a stable surface versus an unstable surface. And this is where you pull in your foam yoga blocks and your blankets and your bolsters. Or if you're in a gym, your foam pad and your BOSU.
00:46:22
Speaker
you have them step on to or step off of, jump on to, hop off of, you know, any variation. You can include lots of jumping movements that give us that bone density building impact training with balance. You can
00:46:37
Speaker
Change directions, you know, I'll have someone go through the little course that I made and then they look at me and I'm like go sideways now, right? So now they have to go in lateral movement through and back and then I'm like now go at the other sideways now go at the other sideways, you know what I mean you can
00:46:54
Speaker
time them and see if they're able to increase their speed right because that's going to mean they're they're increasing their ability to deal with all of these different things you know it's it's really limitless and based on what you're seeing happen with your client then you can adjust the course so let's say you had them jump with
00:47:11
Speaker
both feet into a circle that you made on the ground with a yoga strap or a resistance band and then jump out again. And then they did it really flawlessly and they reported that it wasn't really hard. So maybe next time make them hop in with one leg and hop out or put the circle on top of a bolster or a foam pad or a blanket.
00:47:34
Speaker
And if you are in the homework giving world, which I know some of us are, whatever part of it is the most challenging, but that they are then able to execute safely, even if they don't completely maintain their balance, that becomes their homework. You say, OK, well, now I'm going to have you go home and I want you to take a couple of the couch cushions off.
00:47:54
Speaker
and line them up and you're going to walk one foot in front of the other along the couch cushions or something like that. It's truly one of the most fun things to do. In the PT world we tend to do a lot of obstacle course work in the neuro side where we're working with patients with neurologic challenges and less so in the orthopedic side unless you're working in like a sports clinic and then you have like the ladder on the ground and you're having you know certain athletes hop all over the place but
00:48:17
Speaker
It is really the best. I love it. And I do think, well, first of all, it's definitely way more interesting. You know, bodies like movement, they like challenge, they like things that are interesting and different. And so we know that this is a population that's probably made the circle of movement, the types of movement that they are doing on a regular basis has gotten smaller and smaller. So why not expand it, make it bigger,
00:48:43
Speaker
and let them have a good time while they're at it and applaud their successes, right? And if they lose their balance, then no big deal. It's not, they didn't fall. It's a non-fall is a balancing event. I really hope you enjoyed this episode with all of its lists and that it's given you some new information about balance and falling and some inspiration on how to work
00:49:05
Speaker
on those things for yourself, for your clients, your students. Listen, it doesn't have to be exclusive to your private clients. I have been known in the middle of a yoga class to tell people, OK, two blocks and you have to get from here to the other side of the room, but you can only step on the blocks, which means you're standing on one block. You've got to put the other one down and then you put your foot on that and then you've got to pick the other block up and put the other put it down, right? Walk your way across the room on a yoga block.
00:49:33
Speaker
Why not? God, it's definitely a lot different than anything they've been doing earlier that day, but it's this kind of challenge. It's this kind of variety, variability. It's juicy to your movement system. Your body wants to do these things
Sarah's Enthusiasm for Obstacle Courses
00:49:49
Speaker
that are hard. It wants to solve what looks like a problem. How am I going to get that? How am I going to get my foot off of this block and not lose my balance and put it down on the ground in front of me?
00:49:59
Speaker
Bodies love stuff like that. So why don't we give them stuff like that to do? You get to have two blankets and
00:50:21
Speaker
you have to walk across your blanket pick up the one on the ground behind you carry it to in front of you put it down in front of you there's no limit to how you can do this no limit at all okay i got really excited about the obstacle course i hope i think you could tell but it's it is it's just something i really like them you guys i really like them they're really fun all right
00:50:44
Speaker
you can check out our show notes. There's gonna be all kinds of good stuff in there, like what that table is supposed to look like if you were trying to do it and you were like, I don't understand what this is at all. I'll definitely link to some videos of people doing obstacle courses if you're like, I think I kind of understand, but it's hard to, you're talking about something visual and we're in a listening vibe here. Thank you so much for listening. Finally, it helps us out. If you liked this episode to subscribe,
00:51:10
Speaker
and rate and review it on Apple Podcast or Spotify or wherever you listen to podcasts. We are at movementlogictutorials on Instagram. If you're not following us over there, definitely give it a look. You can go to our website at movementlogictutorials.com and sign up for our mailing list. And I really hope you get out there and build a goofy obstacle course and have a great time doing it. Alright everybody, next time it's going to be me and Laurel.
00:51:37
Speaker
if you're tired of listening to me. And it's our third episode on queuing. And this one's all about feedback, which might not be something that you've paid much attention to. It's a great episode. I really enjoyed it. So definitely give it a listen. All right. Bye.