The 5 Best Balance Exercises

Hello and welcome back again to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy related. As community physiotherapists seeing our patients in their homes, one of the major problems that we encounter is poor balance and the subsequent falls that arise as a consequence of having poor balance. So, I thought in this blog we would have a look at my top 5 exercises to help improve your balance and also have a look at why having good balance is important for all people no matter what age they are and the consequences of having poor balance. 

Why is Good Balance Important?

I think that most people recognise that having a reasonable sense of balance is important or at least they think that it is helpful but many of the patients that we see as physiotherapists are not fully aware of really how important having a good sense of balance is. As I have mentioned and looked at in previous physiotherapy blogs, falls are an enormous problem in the UK and result in large numbers of hospital admissions for fractures, subsequent hip replacements and also unfortunately early death from secondary complications such as infections. Most of these falls are what are classified as "mechanical" which means that the person did not become dizzy or lose consciousness, instead they simply lost their balance, tripped over or caught their foot and were unable to stop themselves falling. Having a good sense of balance and the ability to correct a loss of balance could easily prevent a large  number of falls and certainly with many elderly patients who subsequently break their hip could reduce the likelihood of a hospital admission and the long rehab period afterwards. 

How Can I Know if I have Good Balance?

Now this seems like a straightforward question that should not really need answering. After all - don't you just know if you have good balance or not? Well in truth, some people will believe that they have reasonable balance and when put through some tests it will become apparent that their balance is not good at all. On the other hand as a physiotherapist I have certainly also had many patients who were very worried about their balance and when tested it showed that their balance was actualy very good! 

When looking at the balance of a patient and trying to decide if their balance is an issue I have a couple of quick tests that I ask them to do and which you can easily check yourself. Before doing them though remember that you must only do them if you feel safe to do so and that if you do lose your balance whilst doing them you need to be careful not to fall over and hurt yourself!!

1. Stand on one Leg: sounds simple I know and it is! However it is a very quick way of deciding how good someone's balance is easily and without any complicated scoring system. As a physiotherapist I use this daily with most of my patients to fairly quickly assess their balance. Even if you find that you are able to stand on one leg, you can tell a lot by how hard you are finding it and which areas are working very hard. Try to feel which areas are working hardest and possibly ask a friend to watch you do it.  Also often people will have a difference in balance between their legs and it is worth having a timer on, so that you can time how long you manage on each leg. Generally I would recommend having three attempts on each leg and taking the best result for each leg.

If you can stand for over 1 minute without difficulty then this is a good start and would suggest you have reasonably good static balance. If however you find it very difficult or can't manage a minute then this would suggest that your general static balance is not great and you would be well advised to begin with some balance exercises.

2. Heel to Toe Standing: sounds easy but again this is a really good and quick check of how well you can stand on a narrow area of support. Again, as a physiotherapist I ask most of my patients for whom I am concerned about their balance or gait to do this test. For me it shows how well they can cope when they have smaller base of support and is a slightly easier test than standing on one leg. To do this balance test, simply stand with both feet in line and your heel touching your toes. Whilst doing this, you need to try and feel what is happening and think about which areas are working hard. You also need to swap leading legs, as often there will be a difference between how you feel when one leg is in front. It may be helpful to either look in a mirror or have someone watch you.

Over a minute without difficulty should be your goal for either leg leading. If you can't manage this then I think it is reasonable to suggest your balance needs some work and you would be well advised to have a look at the exercises listed below.

3. Heel to Toe Walking: The previous two tests are what I would describe as tests of your static balance. Which put simply means how well you can maintain your balance in one position without needing to move. However, quite clearly this is only one component of how our balance systems are used in everyday life and obviously most of the time we are moving. Therefore we need a test of your general dynamic balance and how well you maintaing your balance whilst moving. As before this is a test that I use regularly with my patients and gives me a very quick indication of how good their dynamic balance is and doesn't need any special equipment. To do this test, first make sure that you do it in a place where you are able to put your hands out onto something each side of you, so that if you lose balance you will not fall over. You need to pick a line to follow, often one of the floor boards or a line on the flooring in the kitchen will do. Now try to walk along this line placing your heels to toes as if you were walking along a tightrope.

This is the old drink driving test and helps with looking at dynamic balance. You should be able to walk along a line putting your heels to your toes without needing to take a step off the line or finding it too difficult. If you find that you can't do this or that it is very difficult then again I would suggest that you need to work on improving your balance. 

Okay, so what next? Well that pretty much depends upon what the results of the balance tests above show. If you ace them all and have no problems with them, then I would suggest that your balance is pretty good and you don't really need to do anything more unless you have ambitions to take up tightrope walking! However, if you find some of the balance tests difficult, are unable to manage one of the tests or find that there is a significant difference between your legs then I think you should consider looking at my top 5 balance exercises that I use regularlly to help improve the balance of my patients and reduce their risk of falls. 

DISCLAIMER ALERT: Now, please bear in mind that this does not replace the need for a full assessment or seeking medical advice. The tests I have detailed above are just a quick and rough way of you having a look at your own balance. Below I have put down some of the exercises that I find useful as a physiotherapist when working with patients, please bear in mind that you need to be safe when doing these and avoid falling over and hurting yourself!

 

My Top 5 Balance Exercises

So disclaimer over, which are my top 5 balance exercises that I give to my patients to help with their balance and reduce the risk of falls? Well, fairly unsurprisingly I give the tests that I have listed above as balance exercises with one or two tweaks to make the exercises progressive, accessible and slightly more amenable to patients who find them very challenging. 

1. One legged standing: I get my son (who is 5) and most of my patients doing this exercise as it is the fundamental part of having good balance. If you find it challenging or are unable to do this for more than a second or two then there are some ways in which you can make it easier so that you can eventually progress to being able to stand on one leg without support. Firstly, holding onto something with both hands (often the kitchen sideboard works well) and slowly using less support over time can be a great way of progressing towards improving your balance. If you find that you can do this with two hands, try and only use one hand for support and slowly reduce the amount of fingers that you use. Often this way of progressing works well and eventually you should be able to stand on one leg without support.

Sometimes though, patients find that they rely on their hands too much and are unable to reach the point where they let go, so if this is the case for yourself I would try and stand in a corner of your room with something either side of you and then  try to stand one one leg whilst using the objects either side of you for a bit of support or to push you back into balance.   In general you should be able to stand for over 30 seconds on either leg fairly comfortably. This is an exercise that can be done daily and doesn’t need much time to do and can easily be fitted into most people's routines. I would generally recommend you doing this at least a couple of times each day in the early periods when you are wanting to improve your balance.

Eventually you should come to a point where you are finding this too easy and at this point a great progression is to try to do it stood on a cushion on the floor. Sounds easy I know but just try it!!

2. Heel to toe standing: This really is a great and simple balance exercise and is a nice way of reducing the area of support that you need in order to stand in balance. It can also be tweaked and altered easily so that it can match pretty much anyone's current abilities. To attempt the balance exercise just stand with your heel touching your back foot (as if standing on a tight rope) and then try to stay in balance. Over 1 minute should be achievable by most people and should be your target initially. Make sure you swap which foot is leading, so that you can see if one leg is better than the other. This can be a good exercise to use if you find standing on one leg too hard to do and as a separate way fo progressing towards the level of balance needed to stand on one leg. As mentioned it can easily be altered to match your current ability, for example: if you find this too hard you can try and stand in the corner of a room with objects either side of you and then use these to provide some light support and eventually get to the point where your balance is good enough not to need support.Another way of making this particular balance exercise more achievable is by keeping your feet slightly apart - so instead of having your heels touching your toes, you can keep them slightly apart, again with one foot in front of the other but with a gap between your legs. Imagine standing on a slightly wider beam but having one leg behind the other.

For anyone who finds this exercise too easy then trying it with eyes closed will quickly make it much more difficult!!!

3. Heel to toe walking: This will remind you of being a child in the playground at school, trying to walk along a straight line heel to toe. Or possibly the old drink driving test that policemen would ask people to do before breathalysers. For this balance exercise simply pick a nice straight line in your house to follow and walk along this nice and slowly whilst touching your heel to your toe. You should be aiming to do this slowly and in control and without feeling the need to touch down with your foot off the line or rush to the end of the line. As with the other balance exercises above it can easily be made easier or more difficult to match your current level of balance.

To make it easier pick a line that is wider or imagine that your are waing along a beam and instead of keeping your feet in line allow your self a bit of space between them. You can also walk along a corridor where you have some objects or walls either side of you which you can use to touch and push yourself back into balance. For those of you who find this particular balance exercise to easy try walking backwards!

4. Toe walking: This one is great for calf strengthening and foot strengthening. This balance exercise will really help with improving your feel of what is happening at both your foot and ankle. As a physiotherapist I use this with a lot of my patients in order to get them to work on improving their foot control and the strength in the muscles in the feet. To do this balance exercise simply walk on your tip toes for a bit around your room - about 20 seconds at a time should suffice. Really concentrate on staying right up on your toes and the quality of your movement Doing this will improve the strength and control of your foot and give you a better feeling and awareness of the placement of your feet and toes and will eventually transfer over to give you better balance.

As with the earlier balance exercises you can make this one easier as well, just use some support from your hands on something like a kitchen surface. For anyone who still struggles a good alternative is just standing on both feet up on your toes using some support to help with your balance and then over time take less support or build up to taking steps. 

5. Heel walking!! If you weren't feeling a bit silly walking around on your toes then you certainly will with this balance exercise. This is a great balance exercise that focuses your balancing upon your hips, pelvis and core stability by taking your ankles out of the equation. To perform this balance exercise walk around a room just on your heels for about 10 - 20 seconds at a time. For anyone who finds this balance exercise too difficult then make it easier by simply trying to stand on your heels with your back to a chair or bed in case you overbalance. Another option to make it easier is to use some support from an object or potentially a friend or partner's hand.

 

Okay, I hope that you have found this blog about my favourite balance exercise useful and that it has given you some ideas about how to see how your balance is and some exercises that can help improve your balance. As mentioned earlier you must make sure that you are safe when you are doing the exercises and you need to avoid falling over. Think carefully about how you do the exercises and make sure that you have support nearby in case you lose balance. The purpose of improving your balance is to avoid falling over - so you don't want to fall over and hurt yourself whilst doing them!!

If, having read this blog you have some concerns about your balance, want to find out ways of improving your balance further or simply want an assessment for your balance then please get in touch. We are a home visit physiotherapy service based in Lichfield and serving areas such as Sutton Coldfield, Tamworth, Cannock, Walsall, Rugeley and Burton.