The hips are often overlooked in therapy treatments. Through injury (CVA, THA, OA, etc.) and/or aging, patients often lose their ability to effectively use their hips for balance. It is our job, as Physical and Occupational Therapists, to help patients regain steadiness and guard against falls. As such, we need to train them to regain appropriate use of their hips to maintain and regain balance. The following 5 tips will you train your patients to regain proper hip strategies:
1. Add ROM/stretching exercises for hip & back extension. Patients need the ability to extend at the hips and low back in order to have an effective righting response. When balance is lost going backward, hip and back extension is needed to redirect center of mass (COM) forward and recover balance. However, if the patient is stiff into extension, the will not be able to move enough to regain balance, and, unfortunately, will be more likely to fall.
2. Add hip/trunk strengthening. Strong hip flexors, hip abductors, hip extensors, and trunk extensors are key for effective balance recovery movements. Muscles need to act with vigor to slow down COM disturbances and regain balance. Weak muscles are more likely to be overpowered (by body weight and momentum) with smaller disruptions to balance, leading to more frequent falls.
3. Add weight shifting exercises. Weight shifting is moving the body on fixed feet, e.g., the feet stay planted in place as the patient rhythmically moves the body back and forth. Examples of weight shifting directions include side/side, forward/back, and hip/trunk rotations. Weight shifting exercises help build muscle strength and motor control, and are a great way to incorporate the hips in balance training.
4. Add stepping exercises. The ability to take a quick and controlled step is key to preventing a fall, particularly during larger disruptions to balance. When an unexpected or large perturbation is experienced, one's COM is suddenly moved. A patient's ability to step and adjust to this movement, is key to regaining balance and preventing a fall. Adding stepping exercises is helps build strength, control, and improve reactions to disruptions in balance.
5. Add narrow base training. By standing on a narrow surface that does not support the heels and forefoot, the ankle strategy is negated. By putting the ankles at a disadvantage, the hips and core are emphasized for balance. The ADL Hip Stick is a great example of using a narrow surface to emphasize the hip strategy for balancing.