Some patients are prone to a posterior loss of balance, which is incredibly scary and often leads to a strong fear of falling. To help combat this fear, we, as therapists, need to help build their balance awareness and improve their ability to react when balance is compromised.
In respect to balance awareness, start in static standing and observe if your patient bears weight heavier on their heels - you may also notice a tendency for the toes to extend or lift off the ground. Check for the same signs when reaching overhead, looking up, or standing on an incline. Is patient aware of their tendency to bear weight more in heels? For better balance, they should feel equal levels of pressure in the front of the foot as they do in back of the foot.
In respect to one's ability to react, consider posture, hip and stepping strategies. Often patient has a forward bent posture at the hips, trunk and head, which limits ability to extend and push weight anteriorly. Hip strategies are also diminished or absent, and stepping strategies usually delayed and weak. The combination of poor posture and ineffective hip and stepping strategies contribute to falls. Is patient aware of how posture and balance reactions can help prevent falls? To help reduce fall risk, they should improve posture (when possible) and increase the speed and power of their hip and stepping strategies.
Below are 6 exercises to help avoid falling backwards:
1. Static standing. The first sign of posterior balance loss is a feeling of heaviness in the heels and toes lifting up. When performing this exercise focus on feeling equal pressure in the front of the foot as in the back of the foot.
2. Split stance. Standing with one foot slightly forward of the other will lengthen and stabilize the base of support in the forward and back direction. This will add stability and reduce the likelihood of falling backwards.
3. Weight shifting. This exercise is helpful to improve a patient's awareness of their limits of stability (point were balance is lost) and increase their control in shifting or redirecting their weight.
4. Hip strategy. To help avoid falls when balance is lost backwards, it is must to have quick and powerful contractions of the glutes, back extensors, ankle dorsiflexors, and deltoids. The raising of the arms reduces the backward momentum and the trunk and lower extremity muscle contractions help to shift the weight forward again.
5. Posterior stepping strategy. If hip strategies are not sufficient in regaining balance, then the patient needs to be able to confidently step backwards. The quicker they can re-establish their base of support the less likely they are to fall. NOTE: Posterior stepping exercise is at 1:25 mark in below video.
6. Reinforce limits of stability with variety of reaching tasks overhead. Set up balance challenges that will allow patients ample practice at feeling their feet, split stances, weight shifting, and recovery strategies to better prepare them for when they lose their balance in the real world.
About the Author: Shane Haas is a Physical Therapist with 20+ years of experience in the area of balance rehabilitation. He currently serves as Director of Rehabilitation at New Braunfels Regional Rehabilitation Hospital in New Braunfels, TX. He is also President and co-founder of ADL 365 Inc. (www.ADLbalance.com), a company that invents, tests, and makes exercise products by therapists for therapists. Shane can be reached at shane@adlbalance.com.