Opps you did it again. Lost balance in the train that is.
So this happened to me 2x in a row this week. Hence I felt compelled to share about it. I was on my way to work one morning and the train was leaving the station. As usual, there was a jerk with the initial acceleration and suddenly, I felt someone grab my shoulder! Expecting it was a friend, I turned around, prepared to say a big ‘HI’. To my dismay, it wasn’t a face I recognised but an aunty in her 50s who profusely apologised. Working with people with impaired balance abilities on a regular basis, I totally understood. When one loses their balance, your instinct is to grab on the first thing you can find and the grab bars were too far for her and there was nothing else to hold on to.
The second incident happened 2 days after. Again I was on the train and I felt someone grab my bag when it was coming to a stop. I turned back and saw a young man who looked like he was in his 20s who too, like the aunty, lost his balance. I had 2 questions in my mind. The first being: how often does this happen? The second being: why are people’s balance so bad these days.
Balance is the ability to maintain a stable and controlled position of the body. When we have better balance, we are able to maintain equilibrium and prevent falls. Balance however, requires the integration of various body systems.
The Vestibular system.
The vestibular system is located in the inner ear and provides information regarding the body’s position, spatial orientation and movement. They function like an internal gyroscope to detect changes in direction and to help us balance.
2. Vision
Vision is important to provide additional sensory feedback to aid in balance. They help by allowing us to perceive the environment, provide spatial awareness and detect objects. We can orientate ourselves with the surroundings to detect obstacles and hazards along with looking for objects to grab to aid in balance.
3. Proprioception
Proprioceptors help the body have a sense of its position in space, during movements and when forces act on it. They are located in the muscles, tendons and joints and send all its messages to the brain to be processed. After an injury, these tiny sensors may get affected and not work so well. It is hence vital that we retrain them to function normally again.
4. Central Nervous system
The central nervous system is made up of the brain and spinal cord. All the sensory information collected from the visual, vestibular, proprioceptors and sensation gets processed to generate the correct motor response that is smooth and coordinated to ensure that balance is maintained. Disruption of the central nervous system may hinder the ability to maintain balance.
5. Cognitive processing
Attention, concentration and decision making skills are also important for maintaining physical balance. We may miss a step and sprain an ankle if we are distracted while walking down stairs or slip and fall because we did not notice the wet floor.
6. Musculoskeletal system
Next, we come to the musculoskeletal system. Firstly we need sufficient mobility. Mobility comprises the extensibility of muscles and the range of motions of joints. If your ability is limited, the muscles would not have the optimal length/tension relationship to work effectively, resulting in inefficiencies. Also, in severe cases, normal posture can be altered and the centre of gravity will be shifted, causing us to lose balance more easily. We would also require sufficient postural control and muscle strength to control adjustments needed to maintain balance. Insufficient strength will also affect your ability to save yourself in the event of a near miss or a fall.
Let's discuss the various postural adjustments and saving response strategies one may adopt to maintain balance.
Ankle strategy
This happens when the amplitude of unexpected perturbation is small. The perturbation is detected through the joint sensors of the ankle and a small sway occurs from the ankle without any change in the base of support. The head, hip and ankle move together in the same directions to counterbalance the displacement.
2. Hip strategy
This strategy occurs when the unexpected perturbation is large or comes at a fast speed. In this scenario, an ankle strategy is insufficient to maintain balance. This displacement is detected via the vestibular system, and causes the head and hips to move in a different direction. It is called hip strategy as the hip becomes the dominant joint that moves to counter balance while no change occurs within the base of support. Movement here is larger versus the ankle strategy.
3. Stepping strategy
You will commonly see the stepping strategy being deployed when the displacement is too large for neither the ankle nor the hip strategy to be effective. One would take a step either forwards, backwards or to the side in order to change the base of support. By changing the base of support, balance is maintained and a fall prevented. You would need a quick reaction and a strong footing in order to deploy this strategy effectively.
4. Reaching strategy
This was what was being deployed and I was the ‘object’ being reached. This strategy involves reaching with the upper limbs to nearby objects to hold on to. Typically, railings, furniture and grab bars are used. This strategy is usually used when the others cannot be effectively deployed to maintain balance. If your balance is very good, it is less likely you would need to use this strategy unless the perturbation is too large or fast. Using this strategy frequently may indicate a poorer balance.
Now that we have learnt the background regarding balance, stay tuned to the next blog to find out simple tests we can do to assess our own balance and strategies to improve them
Stay healthy. Stay Happy!
