Regaining Postural Stability and Balance

licoricehealthΤεχνίτη Νοημοσύνη και Ρομποτική

14 Νοε 2013 (πριν από 3 χρόνια και 8 μήνες)

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Muscular weakness, proprioceptive
deficits, and range of motion deficits
may challenge a persons ability to
maintain their center of gravity (COG)

May lead to loss of balance

Balance is the single most important
element dictating movement strategies

Dynamic process involving multiple
neurological pathways

Joint position sense , proprioception, and
kinesthesia are vital to all athletic
performance requiring balance

Ability to balance and maintain postural
stability is essential to an athlete who is
acquiring or reacquiring complex motor

Complex process involving sensory and
motor components

Most daily activities such as, walking,
climbing stairs, throwing a ball, require
static foot placement with controlled
balance shifts

Balance should be considered both a
static and dynamic process

Impaired balance is a result of one or a
combination of two reasons

Position of COG relative to base of support is
not accurately sensed

Automatic movements required to bring
COG to a balanced position are not timely
or effectively coordinated

Position of the body in relation to gravity
and its surroundings is sensed by combining
visual, vestibular and somatosensory

Balanced movements also involve motions
of the ankle, knee, and hip joints

Primary mechanisms for controlling balance
occur in joints of the lower extremity

Postural control system operates as a
feedback control circuit between brain
and the musculoskeletal system

Mechanoreceptors transmit messages to
brain through sensory nerves in spinal

Helps to control proprioception or body/joint

Provides information concerning the
orientation of body parts to one another
and to the support surface

Balance is the process of maintaining the
COG within the body's base of support

Within kinetic chain each moving
segment transmits forces to every other
segment along chain

Maintaining equilibrium or balance is
associated with injuries along the closed
kinetic chain

Injuries to any one of the joints or corresponding
muscles along kinetic chain can result in loss of
appropriate feedback for maintaining balance

Human body is a tall structure on a
relatively small base

is quite
high, just above

Somatosensory input is preferred sense
for balance

i.e. : feet in contact with support surface
and detection of joint movement

Visual input

Measures orientation of the eyes and head in
relation to surrounding objects

If eyes are closed balance becomes more

Vestibular input

Sensory system that is leading contributor to
response to movement and sense of balance

Sends signals, primarily to neural structures that
control our eye movement, and to muscles that
keep us upright

Proprioception: ability to determine the
position of a joint in space

Kinesthesia: ability to detect movement

Mediated by mechanoreceptors found in
muscle and joints and by cutaneous, visual
and vestibular input

Joint mechanoreceptors

Found in ligaments, capsules, menisci,
labra and fat pads

Sensitive to change in shape of joint
structures and rate and direction of
movement of joint

Most active at end ranges of motion

Muscle mechanoreceptors

Found in muscles and tendons

Muscle spindles and Golgi Tendon

Muscle spindles sensitive to
changes in length of muscle

Golgi tendon organs sensitive to
changes in tension

Subjective Assessments: Romberg's &
Balance Error Scoring System (BESS)

Romberg's test

Feet together, arms out to side, and eyes

Positive test: sway or fall to one side

indicates loss of proprioception

Balance Error Scoring System (BESS)

3 stances: double , single, and tandem

Completed 2 x each: Once on firm
surface and once on unstable surface
(Foam pad)

Total of 6 trials

Hands on iliac crest and eyes closed

In SL ex. Non stance leg held at 20
degrees hip flexion and 40 to 50
degrees of knee flexion

BESS Assessment Continued

second test begins when eyes close

Single leg stance on non
dominant leg
(NDL) and NDL is in the rear for tandem

Upon losing balance athlete returns to
testing position as quickly as possible

Balance Error Scoring System (BESS)


1 point added for each error that occurs

Hands lifted off iliac crest

Opening eyes

Step, stumble or fall

Moving hip into > 30 degrees of flexion
r Abduction

Lifting forefoot or heel

Remaining out of testing position >5 seconds

Higher scores represent poor balance

Dynamic balance test include functional
reach test, timed agility, figure 8’s,
carioca, or hop test

Ability to maintain upright posture while

Advancements in technology have
provided equipment to quantitatively
assess and train dynamic balance

Mostly computer
interfaced force


Potential to assess possible abnormalities
that might be associated with injury and
help create appropriate training

Stretched or damaged ligaments may
fail to provide adequate neural

May contribute to decreased proprioceptive
mechanisms, and thus decreased balance

Increased postural sway and balance
instability contributed to neurological factors
and biomechanical factors after injury

Rehab program, especially for lower
extremities must include exercises to
improve balance and postural

Any injury can cause disruption at some
point between COG and base of support

If neglected can lead to reinjury, decreased
performance, or other injuries

5 general rules

Safe, yet challenging

Stress multiple planes of motion

Incorporate multisensory approach

Begin with static, bilateral stable surface and
progress to dynamic, unilateral, and
unstable surface

Progress toward sport specific activity

Balance Exercises

Static: COG maintained over fixed base of
support while on stable surface


Maintain COG over fixed base on moving
support or unstable surface

their COG over a fixed base of
support on stable surface through range

Balance Exercises

Dynamic: maintenance of COG over
moving base of support

Usually stable surface, but could be unstable

Base of
always changing position so
COG is forced adjust with each movement


Same as dynamic, but add sport specific tasks

Phase I

Can be initiated once athlete can bear weight
on the extremity

Static, non ballistic exercise

Hard firm surface

Bilateral to unilateral (double leg to single leg)

Eyes opened to eyes closed

Progress to unstable surface, perturbations (taps

or movement)

Overload or stress somatosensory system

Phase II

Transition of static to semi
dynamic & dynamic ex.

Important for running, jumping, and cutting

Progress only if sufficient healing has occurred
and ROM, muscle strength and endurance is

Balance through movement

Controlled hip and knee flexion and smooth
return to stabilization position

Progress to added resistance and more
difficult movement patterns

Phase III

Dynamic & Functional exercises

Slow speed to fast speed

Low force to high force

Controlled to uncontrolled

Jumping or hopping activities

Bilateral to unilateral

Single plane to multi

Exercises may differ between athletes

Be sport specific

Balance and postural stability critical to
athletic performance and injury prevention

A rehabilitation program must include
functional exercises that incorporate
balance and proprioceptive training

Prepare athlete for return to activity

Failure address balance problems may
predispose athlete to reinjury and injury

Use imagination, be creative

Use sport specific tasks