We are still in the first month of the new year, so challenging ourselves to improve our lives is still on the table.  As the name of the article implies, I am going to challenge all of us to improve our dynamic balance.  Our what?  Losing weight, hitting the gym, and improving your diet are all worthy goals, but what is this dynamic balance stuff?

If you have seen me as a doctor, the very first test I do on everyone in my initial exam is a static balance test.  I see if you can balance on one leg with your eyes closed.  The ideal is at least 15 seconds, but what I am really looking for is whether or not you can do at least 2 seconds with your eyes closed.  This is because two seconds and less is highly associated with fall-type injuries.  If you can't balance even two seconds then your ability to navigate any sort of complex terrain is significantly compromised.  You are an accident waiting to happen.

This is good information to have, but in the real world, we generally don't stand in just one place and need to balance.  We need to be able to balance while moving.  This is called dynamic balance.  It is this skill pushed to its limits that set gymnasts, dancers, and athletes apart from the rest of us.  But the 'simple' act of just walking is all about dynamic balance.  You have to balance on one foot while swinging the opposite leg forward, plant that forward foot as you are moving your body forward, and then switch sides and repeat those same movements from the opposite side.  This is dynamic balance in action.  Here

This becomes more complex when you are going up or downstairs – your muscles have to move differently and have more strength.  How about stepping over a small obstacle in your path?  A favorite lately has been managing the tugs and pulls in different directions as you are walking the dog.  How about as you are walking along you notice a pothole you suddenly have to step aside to avoid?  Reaching up to put something on a high shelf or even worse going up and down on a ladder taking those Christmas lights down is a real challenge.  The real killers are when you step on something slippery and your foot slides a bit.  Are you able to catch your balance?  

This is the world of dynamic balance.  We don't have it as a toddler but develop it fairly quickly as we grow.  The nerves that control this system are very much like muscles.  If you use them regularly, they grow and stay strong.  If you sit around at the computer working, recreating, or crashing on the couch, these nerves literally degenerate away.  If you are stuck in bed for two weeks for some reason, those balance nerves are destroyed 50%.  In my experience, it takes many months of work to bring them back again.  The loss of these nerves and the function they provide is what makes us feel old and vulnerable.  Nothing feels more like old age than being unsteady on your feet.  Is it a natural part of aging?  No, it is not.  It is the consequence of lack of movement that challenges this system to stay strong and functional.  You have to do things that require balance to have balance.  Unfortunately, as we get older our aches and pains slow us down and that slowing down creates the balance issues.

Okay, so let's check out your dynamic balance skills.  Standing on one foot, slowly extend the other leg forward as far as you can.  Slowly is the key.  If you can walk we already know you can do this quickly.  Can you do this slowly?  Now swing the same leg backward slowly and then back to the center.  All the while you are still staying balanced on one foot.  Still balanced, now extend the leg out to the side slowly and back slowly.  Finally, still balanced, bend the leg back at the knee bringing the heel up towards the buttocks and then back to center slowly.  How did you do?  Now try it with your eyes closed!  Now try walking super slowly forward and backward, first eyes open then eyes closed.  Try this barefoot or with just socks on.  There are a lot of balance muscles in the foot that don't get used when you have shoes on.

Let's try another one.  Can you simply walk forward heel-to-toe with the toes straight forward without falling sideways?  If that is too difficult, try taking longer steps as though you were trying to walk on a tightrope.  Let's try a third movement, one you might think is easy, but which many patients have trouble with.  Simply balance on one leg with your eyes open and slowly turn your head from side to side.  This one gets folks while they are walking out and about and they suddenly hear something off to one side and they turn their heads to see what it is while still walking.  For some folks that is all it takes to create a fall.  One last test exercise – just rock yourself forward onto your toes and then back onto your heels slowly.  Now try this with your arms raised as high as you can get them.

So how did you do with those little movements?  If your balance system is weak, you may not be able to do any of these exercises easily.  Many of you will need some sort of support like a chair back or a cane to be able to do these at all.  It is important to start where you are.  The big key is to practice balance activities every day for the rest of your life.  As I said before, it takes very little time for us to lose our balance nerves just by doing nothing.  If the best you can do today is to hold onto a chair and stand on one leg, then that is where you start.  As you are able to stay on one leg longer then start to incorporate some leg movement, forward, backward, to the side.  There are lots of balance videos on YouTube.  Here are a couple of characters – Bob & Brad.  

A popular way to counter this degeneration process in some countries are daily Tai Chi movement exercise.  It requires no special equipment, no gym memberships, can be done alone or in a group, and is easily accessible to all ages.  I used to do Tai Chi in my living room following along with an instructor on YouTube.  There are a ton of videos for Tai Chi.  We used to have Tai Chi classes in the office back when we were in our larger office on Sunset Ave.

Another excellent way to build balance is dancing.  Some of my most fit patients over the years were those that danced regularly into their 80s and 90s.  I believe that dancing is a powerful longevity tool.  Not only is it great exercise and balance training, but it also builds joy and happiness – one of the best longevity boosts.  Many studies have demonstrated that health on all levels is directly related to the strength of the patient's social network.  The more good times you spend with other people the healthier you are.  So while doing balance exercises in the privacy of your living room is good, getting out and engaging in movement exercises with friends is much better.  A fun new trend I am hearing about from several patients is pickleball.  It combines balance movement with social interaction in a competitive environment that is easy to learn and play.  Here

For those that are not competitive, I recommend something like a Five Rhythms class.  Based on the book The 5 Rhythms by Gabrielle Roth. It gives you the opportunity to engage in free-form dance based on the principles outlined in the book.  It is a lot of fun, and they even have an online Zoom version here in Sacramento.  5Rhythms Dance | Centered Sacramento

Dynamic balance is vital for everyone at all times.  Back in the old days when most everyone had a much more physical lifestyle, dynamic balance was naturally incorporated into everything you had to do.  If you think back to pictures from a couple hundred years ago, who did you see walking all hunched over and needing a cane?  Bankers.  They were like the folks with computer jobs today – chained to their desks all day hardly moving at all.  Now everybody has a banker-type job it seems.  So we need to consciously engage in activities that require us to balance while moving.  I have had two patients in the last month that have fallen and broken their hips – folks I now consider middle-aged, not old.  Would this have happened if their dynamic balance was better?  Probably not.

Keep it moving and take care,

David 

Ellen update:   

Many thanks to all the people that dropped off flowers for Ellen on her birthday.  I think we have used up every vase we have in the house.