Postural Balance Defined
Posture is characterized as ideal body mass distribution of the patient upright in relation to the force of gravity. Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity. Postural control strategies may be either predictive or reactive, and may involve either a fixed-support or a change-in-support response (Pollock et al, 2000).
Patients with proper postural balance can resist gravity with upright extended posture, and are able to avoid postural collapse with dynamic movements. Balance is the ability to maintain equilibrium by positioning the center of gravity over the base of support of body. Maintaining postural balance requires censorial detection of the body’s movements, integration of sensory-motor information into the central nervous system, and an appropriate motor response.
Maintaining postural balance requires censorial detection of the body’s movements, integration of sensory-motor information into the central nervous system, and an appropriate motor response.
Bodily Systems Working In Balance
The position of the body in relation to space is determined by visual, vestibular and somatic-sensitive functions. Muscular control and dynamic maintenance of balance involve the activity of coordinated of muscular kinetic chains achieved by cerebellar output.
Visual input is fundamental for body orientation within the environment, somatosensation is how you feel your environment and your brain’s perception of joint movement, and the vestibular system is for extension and equilibrium. The cerebellum’s influence on postural balance is through flexor/extensor synergy and small shifts and adjustments to the posture system.
Although the vestibular system is the most important system for postural balance, inefficiencies of the visual system, cerebellum, and somatosensory cortex will affect or even override the patient’s ability to balance upright against gravity.
Your Patient’s Balance
Consider common factors that may be affecting your patient’s ability to balance properly. Especially if they have been doing balance training and are not improving.
The ankle joints play an important role in maintaining postural stability. Loss of postural control has been consistently observed in patients with chronic ankle instability and after an acute ankle sprain. Ankle manipulation has excellent potential to assist in the treatment of a variety of foot disorders related to postural instability. When appropriate for the patient, ankle manipulation may have high clinical benefit (Paes, 2013).
Various cross crawl exercises are a way to reprogram the nervous system, spinal muscles, and postural balance. Humans are contralateral beings in reference to their neurological organization. This is what is meant by a contralateral, cross pattern neurological organization.
“Cross-Crawl” is a learned pattern of movement that is developed as infants are crawling on the ground. This skill is further developed by learning to walk and run. The complex patterns of which are stored in the nerve messaging patterns of the cerebral cortex, the cerebellum and spinal and peripheral nerves. These manage the switch on/switch off coordination of the muscles of locomotion, posture and corrective activity to maintain balance.
All of your bodily systems depend on cross-crawl integration, even cerebral activities. Patients who lack cross crawl integration are more clumsy and have less control of postural balance.
Postural balance is also affected by postural hyperkyphosis. Research was conducted to assess the effect of a proprioceptive dynamic posture-training program on balance in osteoporotic women with kyphotic posture. The subjects who had abnormal balance and used the proprioceptive dynamic posture-training program had the most significant improvement in balance (Sinaki, et al., 2002).
Given that impaired balance is associated with an increased propensity to falls, improvements in balance may reduce that risk. The flexed posturing that often develops in elderly persons may place their center of gravity closer to their limit of stability. Balance, gait, and risk of falls among the elderly improves significantly with proprioception training programs (Sinaki et al., 2005).
Improving Postural Balance
Balance is an important topic, and balance training is fundamental for posture rehabilitation. Consider these three ways to improve Postural Balance that you can implement with your patients.
- Adjust the Ankles: When appropriate for your patients consider adjusting their ankles. Manipulation of the joint space will improve proprioception to the ankles and feet within Posture Quadrant 4, allowing the patient to have better control of their body in proper balance over their feet. Adjusting the ankles will increase proprioception and sensory awareness of the ankle joints to improve postural balance.
- Cross-Crawl Exercises: Cross-crawl exercises can be as simple as taking a walk, or as complex as the “Speed Skater” exercise or a back lunge through the full range of motion and bringing the knee up to the chest. Regardless of your patient’s current level of postural fitness, they can benefit from cross-crawl exercises to improve postural balance. The basis of all cross-crawl moves is to have one arm go forward and simultaneously the contralateral leg go back, and vice versa.
- One-Leg Balance: Balancing on one leg with proper upright postural design is the fundamental exercise for vestibular system training. Have the patient stand on one leg with their shoulders back, spine straight, core musculature engaged, head pulled back, and eyes parallel to the horizon. Patients should train themselves to hold this position for a minimum of 30 seconds for best postural balance results.