Motor control

Disturbance-Based Balance Training: A Lesser-Known Way to Improve Motor Control and Minimize Falls

Disturbance-based balance training might be one of the most versatile fitness techniques you’ve never heard of today. Featured as a way to prevent falls in the elderly and people with neurological disorders, it can also help recreational and elite athletes avoid injury and speed up rehabilitation. Whether your goal is to age in place or improve your performance, disturbance training can help.

The practice takes its name from a lesser-known definition of disturbance: “A deviation of a system, moving object, or process from its normal or normal state or path caused by an outside influence.” . The goal of disturbance-based balance training is to use exercises and exercises to fine-tune your body’s response to anything that might disturb your balance – whether as a result of sports, aging. or conditions such as a stroke.

The way these disturbances are generated during training varies widely., depending on your age, physical condition and state of health. Actions might involve standing on an unstable surface, for example, or even being pushed. But if you start to fall, you are doing it right. In fact, you should start dropping about 30% of the time per PBT session, says physiotherapist Kevin Wilk, associate clinical director at Champion Sports Medicine in Birmingham, Alabama, and assistant assistant professor of physiotherapy at Marquette University. “That’s what’s going to produce better engine control changes. “

By experiencing situations where they start to fall and then catch up, people can improve their motor control and help minimize their risk of falling when they lose their balance in real life, whether on stairs or on the playing field.

How the PBT works

According to Robert Donatelli, a Las Vegas-based physiotherapist whose patients include professional athletes, Olympians, and the elderly with neurological disorders, balance depends largely on three factors: vestibular performance or the functioning of body structures. inner ear which give your brain information about your position; vision; and proprioception, aka kinaesthesia, or your body’s ability to sense where your limbs are in space and how much force they will need to generate for a given movement. If you challenge any of these systems – by standing on an unstable surface, for example, or closing your eyes or moving your limbs – “it will make others work harder,” says Donatelli.

In PBT, the challenges are about reactive control of a person’s balance (the kind that helps you recover when you start to fall), rather than anticipating a person’s balance control, which helps you maintain balance, says Avril Mansfield, senior scientist at the Kite-Toronto Rehabilitation Institute, part of the University Health Network of Canada, and associate professor in the Department of Physiotherapy at the University of Toronto. This is why PBT training is also known as reactive balance training. (This is also called disturbance-based walking training.)

The challenges differ according to fitness levels. For recreational athletes, PBT may involve standing on one leg for 30 seconds with your eyes closed. Elite athletes, however, might do the same and have no problem maintaining their balance; in this case, they may need to move to an unstable surface, such as a bosu ball, and stand on one leg and catch or hit a ball to test reactive balance.

Who can benefit

According to Mansfield, PBT has been shown to prevent falls in people diagnosed as stroke, spinal cord injury, Parkinson’s disease, and traumatic brain injury. It’s also helpful for anyone over 65, she says, as losing balance is part of normal aging.

She was the lead author of a 2010 double-blind, randomized, controlled study that found that PBT significantly reduced the risk of falls in older people. A 2014 study found that just one session of PBT in healthy adults aged 65 and older halved participants’ risk of falling.

Although a 2020 study in which high-risk older people walked on a treadmill found that PBT had no significant impact on their risk of falls, it concluded that training played a role in preventing fall-related injuries. Researchers hypothesized that therapy prevented people from having significant falls (as opposed to minor falls) or that it has better equipped them to partially recover their balance, resulting in a more controlled fall.

In terms of sport, Wilk says, PBT benefits all athletes whose sports require dynamic balance, such as gymnasts, basketball players, skiers, footballers and trail runners. “Everything is linked to this,” he said. Several studies have shown that it can prevent the types of injuries commonly associated with ball sports, particularly ACL tears, Wilk says.

He cites a study that found college footballers who included disruption drills in warm-ups reduced injury rates by nearly half compared to those who didn’t. The study authors said the exercise increased core muscle activation, creating an “optimal state of physiological readiness.”

It can also help with rehabilitation, he says. A study of physically active adults undergoing non-operative treatment for acute ACL tears found that those who participated in PBT were less likely to have their knees flexed during exercise than those who participated in other forms of rehabilitation. . According to Wilk, an ACL tear can compromise joint proprioception. Disturbance training engages the appropriate brain centers to restore proprioception skills.

But it’s not for everyone. According to Mansfield, people who should avoid it include anyone with acute trauma, severe osteoporosis, those with weight-bearing restrictions, and anyone with cognitive impairment that compromises their ability to understand the purpose of the exercises. or to communicate pain or discomfort.

What to expect during a sessionDisruption exercises “don’t have to be complex, they just have to be difficult,” explains Wilk. For example, high-risk seniors who participated in the 2020 treadmill study wore safety harnesses while physiotherapists challenged their balance by changing the direction of the belt or abruptly changing speed.

A less technological option for high-risk or neurologically compromised seniors would be performing mini-squats with their hands on a sturdy table, Wilk says. If that goes well, “then we ask them to remove (their) hands or keep one finger on the table and close (their) eyes and do this squat.”

Tandem or tightrope walking is another option that can be tweaked to match a variety of ability levels, Mansfield says. This technique requires you to walk while maintaining a narrow stance, placing the heel of your front foot directly in front of the toes of your opposite foot. If that’s too easy, try it with your eyes closed and / or on a foam surface – but still under professional supervision.

According to Wilk, “the plane” is a classic movement with variations to meet different levels of ability. Stand on one leg with a slight flexion of the knee. With your arms straight, lean forward from your hips. When your back is almost parallel to the ground, extend your arms out to the side and twist your trunk back and forth, as if you were “landing the plane.”

If this move alone doesn’t test your balance, try it with closing your eyes, wearing glasses coated with petroleum jelly to distort your vision, standing on a piece of foam, carrying a backpack, holding dumbbells. , standing on a Bosu ball and / or using an oscillating board. If it’s still too easy, don’t be surprised if your trainer or physiotherapist gives you an unexpected boost.

For capable athletes, imagination is the only factor limiting disruption training. Donatelli describes working with an elite dancer who could stand on one leg atop a piece of foam resting on an upside down Bosu ball located on a platform suspended from the ceiling by several chains. Over time, she developed the ability to maintain her balance while throwing a ball against a mini-trampoline.

The optimal frequency and duration of your sessions depend on your goals. For those at risk for falls, two to three closely supervised one-hour physiotherapy sessions per week are ideal, Mansfield says. One study found that stroke patients who did this for as little as six weeks experienced lasting benefits a year later. Athletes should aim for three 20-minute sessions per week, says Donatelli. But even including a five- to 10-minute session as part of your warm-up or cool-down would be “fantastic,” Wilk says.

Find a professional

A key part of safe PBT training is finding the right advice. Make sure your fitness professional or physiotherapist has the bandwidth to focus only on you during your session. “It’s very interactive,” says Wilk. “They really have to watch you to create the ‘right’ adaptive challenge.”

While there is no formal certification for disturbance training, Wilk notes that there are graduate programs that focus on motor control. The guiding principle of disturbance-based balance training is simple, says Wilk: “A small failure is okay.” Nor is it bad advice for life in general.