#59 Balance Training

How to Stay on Your Feet with Neuropathy- Balance Training for Peripheral Neuropathy

Is the sensation of wobbling when you walk or stand a familiar one? Do you struggle with maintaining your balance? Well, you are not alone! Plenty of people struggle with their balance for a variety of reasons. Balance training can help with that.

Balance is the strength that maintains the distribution of our weight to keep us upright on our feet- or maybe even hands if you are a master yogi. Balance is a key component of all functional movements and makes up day to day activities such as weaving through people on a crowded sidewalk, turning down the aisles of a grocery store, standing up off the couch, or jumping into bed at the end of a busy day.

Why Do We Wobble?

Our balance can become compromised in many ways. As we age, we often progressively lose our balancing abilities. This typically happens due to a loss of muscle strength, joint flexibility, and a loss of neural connections for balancing. When our balance starts to go, we risk falling, slipping, and injuring ourselves. A lack of balance becomes even more dangerous when accompanied by hazardous conditions such as an icy sidewalk, slippery driveway, etc.

Balance, or rather a lack of, does not only affect our physical health and well-being but can also have immense impact on our mental health. Aside from physical injury, losing balance and falling can often be embarrassing. When we are constantly anxious about losing balance, or falling, it can be hard to get motivated to get out of the house, be active and even see friends or family. It is for these reasons, both mental and physical, that it is important for us to maintain adequate balance.

How We Can Work on Our Balance

Luckily for us, balance IS a skill that can be strengthened through practice and exercise. In general, movement and exercise of any sort can be an excellent way to work at our balance and certain activities like yoga and Thai Chi, where balance is a key component of the practice, are even better. Not one for yoga or Thai Chi? Well then, why not just simply practice balance training. Balance training involves exercises that focus solely on strengthening our mental and physical muscles for balancing. It helps to train our body’s sense of proprioception (knowing where our body is in a given space) and has been shown to preserve nerve function while promoting nerve regeneration.

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Balance Training Exercises

Are you feeling ready to start balance training? If so, you’re in the right place! Below we have a number of well researched balance exercises alongside progressions for each exercise. These are exercises which you can practice in the comfort of your own home, in just about any room in the house. We have suggested progressions for each exercise as well as how frequently to do them. Each exercise can be modified to be made easier or more difficult. As your balance increases you can move to harder progressions to challenge yourself even more. The following balance exercises are permitted for beginners, however, as always we recommend communicating with your physician or physiotherapist if you are unsure about whether or not balance training should be in your practice.

Before we begin any of these exercises we need to make sure that we are balance training safely by always having a stable object, such as a wall, handy to lean on for stability. When using this object for stability, try not to set all your weight on the object, but instead use it with a light hand to maintain stability.

The Tree Pose

A terrific way to gauge our balancing capacity is to stand on one foot – aka the tree pose. How hard is it for you to stand on one foot? How long can you stand on one foot?

If you notice that you are struggling to stay up whilst on one foot, or can’t even make it up onto one foot, then you should practice this exercise with a sturdy object. First off, find your object, perhaps a counter-top or wall, and stabilize yourself with both hands. Once you feel stable against it, begin to shift your weight onto one foot (that will stay on the ground) and begin to lift the weight off your second foot. Shift your weight until you are comfortably planted on one foot. If you can hover your foot an inch above the ground, that is okay, but if you feel comfortable, bring your foot higher- once you feel comfortable with the height of your floating foot, hold this position for a few seconds. Repeat with the other foot.

*Pro tip – a great balance tip is to look at one non-moving spot such as a spot on the wall you are facing, etc.

As this exercise becomes easier, start doing it with only one hand stabilizing us, then eventually only a finger, and once that becomes effortless practice removing the support and balancing solely through the grounded foot. Remember though, even at this stage we want to be proximate (near) to a support just in case we lose our balance.

Tree Pose Progressions

Once we have worked our way up to smoothly standing on one foot without support, we will practice the full tree pose. We begin this pose by once again balancing on one foot. Once we are balanced in this position, we will bring our hands together either at heart centre behind you (pictured left) in front of you (middle picture) or above your head like a tree (pictured right).

In tree pose you can put your foot wherever it feels comfortable, whether that be held in the air, against your calf, or if you’re looking for a challenge for both flexibility and balance, your inner thigh. It is important though to do what feels right for you and to put your foot where it helps your balance most. Explore how long you can hold each moderation of this pose and how that length of time progresses with practice.

Kitchen Counter Calf Raises

To start this exercise, we must have something to hold on to for stability- an easy object may be a kitchen or bathroom counter, a railing or even a door handle.

Our starting position will be standing flat footed facing and holding onto your counter (or other stabilizing object). From here, we begin to shift the weight of our foot forward onto our toes so we can lift our heels above the ground. When we are on the balls of our feet/toes and our heels are lifted, we will try to hold this position. If you catch yourself losing balance, lean into the stabilizing object more. As this exercise becomes easier, we want to continuously lessen our pressure on the counter. You can make this exercise easier or harder by increasing the time that you are holding yourself on your toes, or by increasing the repetitions you are doing.

If you have any sort of ankle injury or if this exercise causes pain, then do not engage in this exercise.

Calf Raise Progressions

If the above rendition of a calf raise is easy, or becomes easy, then moderate this exercise to make it more challenging. There are two excellent ways to do this, the first one I would recommend is trying to do a calf raise on the stairs.

Calf Raises-Stairs

This adaptation of a calf raise challenges our balance even more by having our heels hanging off the stairs, creating a larger range of motion. Not only will you be working on balance in this exercise, but you will also be giving your calves a major burn. For safety reasons, it is recommended to do this exercise on stairs that have a railing and to practice this exercise at the bottom of the staircase instead of the top.

One Legged Calf Raises

Another excellent variant of the calf raise is the one-legged calf raise. We can do this similar to the two-legged calf raise by stabilizing ourselves on a counter. Be sure to do this exercise equal amounts on each leg to ensure you are working the muscles in each leg equally.

Side Leg Raises

Using your chair or a wall you will want to balance yourself with your feet slightly apart. Slowly lift one leg to the side whilst maintaining a straight back with your head facing forward. Lift your leg as high as you can whilst maintaining your balance and then hold at the peak height for 5 seconds, then slowly bring your leg back to the resting position on the ground. Do these 10 times on each leg.

To make this exercise more difficult, challenge yourself by removing pressure first from one hand whilst doing this, then removing that hand completely so that you are stabilizing yourself with only one hand. Eventually, you may even be able to do this without any hands to balance yourself. 

Practice makes perfect and consistency is key!

References

Balance Training for Neuropathy. (2017). Retrieved February 21, 2020 from https://www.healthline.com/health/exercises-for-peripheral-neuropathy

Exercise Physical Therapy For Neuropathy. (2016). Retrieved February 12, 2020, from https://www.foundationforpn.org/living-well/lifestyle/exercise-and-physical-therapy/#balance

Harvard Health Publishing. (2007, March). The benefits of balance training. Retrieved February 12, 2020, from https://www.health.harvard.edu/newsletter_article/The_benefits_of_balance_training

Pan, X., Jiao-Jiao, B. (2014). Balance Training in the Intervention of Fall Risk in Elderly with Diabetic Peripheral Neuropathy: A Review. International Journal of Nursing Sciences, Volume 1, Issue 4, December 2015, Pages 441-445.

Tofthagen, C., Visovsky, C., & Berry, D. L. (2012). Strength and Balance Training for Adults With Peripheral Neuropathy and High Risk of Fall: Current Evidence and Implications for Future Research. Oncology Nursing Forum, 39(5). doi: 10.1188/12.onf.e416-e424