When someone’s fitness level is assessed, we tend to measure strength, endurance and flexibility. In my practice, I also like to look at someone’s functional capacity. My clients are usually with me because a loss of balance and/or stability make it very difficult for them to do things they love, like hitting a golf ball, riding a bike or even just going for a walk.
Losing balance can occur from a number of factors. Diseases like Parkinson’s, MS, stroke and arthritis interfere with the body’s ability to maintain balance and stability due to dysfunction of the muscular and nervous systems. Even in healthy individuals, the cells in the part of the brain that help us to stay upright begin to die off as we age. When this happens, it gets harder to correct the body as it moves through space and has to navigate things like curbs, stones or uneven surfaces. Vision and hearing problems make it difficult to channel information and the use of some medications and/or blood pressure issues can result in dizziness.
Loss of muscle strength, power, co-ordination and reflexes can play a massive role in someone’s ability to balance and stabilize themselves in their everyday lives and in their extracurricular activities. Fortunately, this is the area where we have the most control and where I am most able to help people.
As part of a two-part series on assessing and improving balance, here are my favourite ways to judge the balance and stability of my clients.
1. Single Leg Hold
Stand on one foot and time how long it takes before you touch your opposite foot to the ground. Record your score and repeat with the other foot. If you have serious balance issues, stay near a wall or chair that you can grab in case you wobble.
2. Abdominal Plank
Balance yourself on the floor from your toes and your elbows for as long as you are able to hold, pain free. Do not hold your breath in this position! This is a great measure of core strength and stability.
3. Single Leg Chair Touch
This is a much more advanced version of the Single Leg Hold. Balance on your left foot in front of a chair. Bend at the left knee and touch the chair as many times as you can with your right hand. If you stumble and have to touch the floor with your opposite foot, continue where you left off without restarting the timer and record how many touches you get in 30 seconds.
4. Standing to Lying to Standing
This test should not be performed by people with low blood pressure, back pain or problems with dizziness. Stand in front of an exercise mat and start a timer for 60 seconds. Lie down on the mat on your back and then stand back up. Record how many times you can go from standing to lying to standing in 60 seconds.
5. Modified Standing to Lying to Standing
I came up with a modified version of this test for seniors or others that find it challenging to simply get on the floor. Rather than repeating for 60 seconds, I have the client lie down and stand up only once and then record the time it takes.
6. Timed Up and Go “TUG” Test
This test is very useful for people with conditions like MS, Parkinson’s and Arthritis or post-stroke. The client sits in a straight back chair and a spot is identified 3 metres away. At a signal, the client will rise (using assisting devices if necessary) and walk to the 3 metre mark, turn, return to the chair and sit down. Their time is recorded for retesting later on.
I’ll pick and choose from the tests outlined above depending on a client’s current fitness level and or level of impairment. When I get a score, we’ll use it to compare to a retest every few weeks. Recently, I had a client improve on the Stand to Lie to Stand from 4 to 8 ½ repetitions in just 4 weeks and another client decrease his Modified Stand to Lie to Stand score from 105 seconds to 28 in the first month. These improvements are significant and will have a huge impact on their daily lives.
Next week, I’ll let you in on some of the exercises that my clients use to get the kind of improvements that carry over to their lives in meaningful ways.
I’ve started physiotherapy for my surgically repaired shoulder in the past week. This means that I’m working on strengthening and moving it more these days. I’m a little sore today, but I was able to shovel top soil into the garden on the weekend, play a game of pool and even strummed my guitar for the first time in two months. Slowly, but, surely I’m getting back in the game.