Posts Tagged ‘Balance’

Great Info from the Gray Institute Newsletter

TWEAKOLOGY is the transformation of the notion (what we know about function) into the motion (what function looks like).  Knowing that every “tweak” will create a different reaction, mindfully chosen “tweaks” provide the foundation of the exercise strategies that are specific for each individual.

This month we highlight the BALANCE REACH as our exercise and use SPEED as our “tweak”.  Before we further describe the exercise, let’s discuss balance in general.  Balance is a state of equilibrium, it is dynamic in nature, it requires a combination of stability and mobility or “Mostability”.  Balance does NOT require stillness and is hampered by rigidity.

Back to the task at hand…SINGLE LEG BALANCE REACH.  Two things to look for when observing this exercise are: 1) how far the individual can reach their and 2) the ability to transform the direction of the movement.  Let’s perform three different foot reaches at ground level using the three cardinal planes 1) Sagittal Plane (click HERE to view) 2) Frontal Plane (click HERE to view) 3) Transverse Plane (click HERE to view).  Perform 3-5 repetitions with each foot at a self-selected speed.  Observe not only the reaching foot and leg, but observe the “balance” leg.  Also observe the reaction of the trunk, the shoulders and even the head and hands.  Does each side react the same?  Is there similar control demonstrated?  Similar ranges of motion throughout the body?   Similar quality of movement through the Chain Reaction™?  Now let’s tweak it.  Repeat the balance reaches with decreased speed.  How does decreasing the speed affect control, range of motion, and quality of movement?  If the body senses a loss of stability and control, with the simple tweak of increased or decreased speed it will react with an immediate neurological stiffening to add control back into our system – to prevent one from falling.  Remember, it is always about preserving ourselves within our environment.  As you experience a stiffening effect, do not worry – but note the difference between fluidity in motion versus rigidity.

Find the speed of your success.  Also find the speed of success for those that you are assessing, training and rehabilitating.   Depending upon the function that they are looking to improve, condition the movement with slightly decreased speeds and slightly increased speeds, over time without sacrificing fluid efficient movement.

As always, safety is the number one concern.  Any time you believe you are not able to complete the movement without the need for additional stability, make sure that you are performing the balance foot reaches in a doorway, next to a wall, or next to a chair or even having someone else control you through hand stability.  Remember to provide the same safety net and opportunities for your patients and clients.




By Andrea Wasylow PT, FAFS  

  The  billing  coordinator  at  the  small  hospital‐based  rehabilitation  clinic  where  work  is  

phenomenal.  In  addition  to  being  one  of  those  people  who  you  just  enjoy  spending  time  with,  

she  is  exceptionally  skilled  at  finding  those  small  discrepancies  that  could  potentially  delay,  or  

give  reason  for  denial,  of  payment  for  services.  Prior  to  joining  our  team,  she  worked  at  well  

meaning,  yet  very  “conventional,”  physical  therapy  practice.  Since  coming  to  work  with  us,  we  

have  had  many  conversations  discussing  the  principles,  strategies,  and  techniques  behind  

treatment, based on an Applied Functional Science approach.  


One  such  discussion  occurred  recently  when  she  asked,  “Can  you  help  me  understand  why  

‘balance  stability  training’  was  included  as  part  of  the  treatment  plan  for  this  patient  being  

seen  for  shoulder  diagnosis?”  The  discussion  that  followed  highlighted  some  of  the  

misconceptions  surrounding  balance  rehabilitation  and  training,  and  hopefully  helped  provide   

better understanding of balance as an integral part of all function.  


Our  coordinator  had  become  accustomed  to  seeing  static  testing  on  the  ground,  or  on  less  

stable  surface,  as  common  way  to  determine  whether  or  not  an  individual  had  “good  

balance.”  Unfortunately,  someone  who  may  do  well  standing  on  one  foot  with  their  eyes  closed  

for  predetermined  period  of  time  may  stumble  or  fall  when  turning  to  look  at  who  just  called  

his / her name while he / she was walking.  


Though  commonly  used,  these  traditional,  static  tests  provide  limited  information  when  the  

fundamental  truths  about  balance  are  understood.  Balance  is  dynamic  and  three‐dimensional.   

It  is  our  body’s  ability  to  integrate  the  information  from  all  of  our  body  systems  during   

functional task and  use that information to displace our center of  gravity. The system  must  then  

decelerate  that  motion  and  either  bring  the  body  back  or,  more  likely,  move  in  completely  

different  direction.  Three  of  the  main  systems  that  feed  the  body  information  are  the  vestibular  

system,  the  visual  system,  and  the  proprioceptive  system.  Though  there  is  minimal  amount  of  

information generated to those systems in a static position, it is motion that truly “turns on” and  

feeds  these  systems  the  information  required  for  function.  Balance  requires  the  ability  of  the  

neurological  system  to  successfully  receive  information,  process  that  information,  and  then  

convey  an  appropriate  motor  plan  for  task  completion  –  all  while  controlling  the  center  of  mass  

against  gravity.  Balance  requires  range  of  motion  and  strength.  If  body  segment  lacks  motion,  

then  not  only  do  accommodations  of  additional  motion  in  other  areas  need  to  be  made  to  

complete a task, but proper muscular loading and exploding at the restricted joint can not occur.   

Balance  can  be  impaired  if  the  surrounding  musculature  is  unable  to  control  movement  into  

that  motion,  even  when  full  passive  range  of  motion  is  available.  Most  importantly,  balance  

requirements are determined by the functional task the body is being asked to perform. In order  

to  insure  successful  task  completion,  the  individual  should  be  able  to  control  three‐dimensional  

motion  beyond  that  required  of  the  functional  task.  Balance  rehabilitation  and  training  

programs should reflect that goal.  

 The patient whose chart our billing coordinator was reviewing happened to be an avid gardener.  

She  loved  her  flowerbeds  and  spent  significant  amounts  of  time  on  her  hands  and  knees  

weeding.  Her  balance  deficits  showed  in  this  position  when  she  would  bear  weight  through  her  

involved  upper  extremity  and  reach  with  her  other  hand.  Frequently,  she  had  to  quickly  move 

the  reaching  hand  to  the  ground  in  order  to  avoid  face‐planting  into  her  flowers.  As  it  turns  out,  

she  had  thoracic  spine  and  scapulo‐thoracic  range  of  motion  restrictions,  as  well  as  an  inability  

to eccentrically control the motion that her involved shoulder needed in order to accomplish the  

reach  distances  required  by  the  other  arm  for  weeding.  Thankfully,  with  training,  this  individual  

was  back  doing  the  gardening  that  she  loved  without  difficulty.  Also,  “armed”  with  additional  

understanding  about  balance,  our  billing  coordinator  was  able  to  coerce  payment  for  services  


Get Strong! Stay Strong!



Great for balance and muscle control of lower extremity.  Works muscles and balance receprors in integrated fashion.  Can begin with reaching foot tap for control and progress to no tap/touch to challege balance, eccentric control and return.  Can vary stance foot surface, do with one eye closed.  Put hands behind back or head to take away arm steady effect.  Can do singles or do multiple target reaches.  Have fun and be creative.  Don’t forget to think of muscle and joint reactions that are occurring and ask if that is what you are trying to achieve or teach.

Get Strong!  Stay Strong!