The Semantics of Balance

 

     The second leading cause of falls in the elderly population is a fear of falling. Among the general population, we psych ourselves, react badly, become easily distracted or, simply just accidentally fall. The leading cause of falls among the elderly is medication, and among the general population, well, certainly we fall when under the influence of substances that alter our sensorium. True disorders of balance are rare. Balance may be defined as a state of bodily equilibrium; to bring to or hold in equilibrium; or to arrange, adjust, or proportion the parts of symmetrically. 



     Increasingly these days people report more problems with balance, or are being told by physical therapists and exercise trainers that they have problems with balance. We interpret this to mean that we are having some neurologic disturbance, assume that as we age we lose dexterity and agility and for some minority of us, this is true. But for most of us, consider another possibility. Independent of age, related solely to conscious choice, most of us perform a limited number of similar actions daily, using the same motions, the same muscle groups repeatedly. We bend forward often, but backwards rarely. We lift loads upwards, but hardly press loads downwards. We practice moving our joints and muscles in only a fraction of their intended motions functionally. Over time, we develop an “imbalance” in strength and in flexibility. We are more practiced in moving forward than backwards, moving to the right than to the left (for the majority of us), climbing up versus descending downward and when we move in the more practiced directions we feel more surefooted.
This is in part neurologic but it is also strength, agility and cognitive feedback together contributing to a more complex motor planning.

Add impact activities like skipping

     In the absence of a true neurologic disorder, the most effective plans to improve our balance involve restoring normal mobility across the major joints and balancing the strength of the major muscles that pull across the joints. Performing exercises that use muscles in a functional capacity allows the muscles to be trained as well as strengthened. Muscle and nerve fibers have the capacity to “learn” and “remember” and we should capitalize on this concept. If one just walks for exercise, than all one is training for is walking. By adding some impact activity, by shifting direction, changing pace or plane in space, one trains the muscles, joints and proprioceptive neurons to remember that they all really do know how to do all those things.

Move against resistance in varied planes

Whooping

 

     In 1957, an Australian company began making wood rings for sale in retail stores. The item attracted the attention of Wham-0, a California toy manufacturer. The next year Richard P. Knerr and Arthur K. Melin, of Wham-O, manufactured a plastic hoop in a variety of bright colors. The Hula-Hoop was an instant success. Before the 1950s people were doing much the same thing with circular hoops made from grape vines and stiff grasses all over the ancient world. More than three thousand years ago, children in Egypt played with large hoops of dried grapevines. The toy was propelled along the ground with a stick or swung around at the waist.

 

       A common practice in medicine, we look back to our past for ways to improve our futures. Using a hoop, or hooping, allows for a number of health benefits making hooping worth re-visiting. The circular and side-to-side motion helps restore segmental spinal mobility. Like a chiropractor mobilizing the spine manually, the gentle repetitive swing hooping introduces safely increases each vertebras’ slide over its neighboring bone undoing the soft tissue restrictions we develop through limited motions and long times spent in static postures. Anything that restores mobility acts in a similar way to stretching, so the spine’s flexibility is enhanced. 

 
     The Cooper Institute, in Dallas, Texas is a nonprofit institute that has provided research and educational programs focusing on exercise physiology, behavior change, health communication, children's health, obesity, nutrition, aging, diabetes, hypertension, physical activity intervention, and health promotion. According to a study run by the Cooper Institute, one minute of hooping burns as many calories as running an eight-minute mile or taking part in a high impact aerobic class (though I add a caveat that baseline condition might influence this). So hooping can supplement regular low impact cardio workouts, increasing cardiac stamina. Hooping will definitely promote aerobic exercise within the metabolic fat burning exertion ranges so offers alternative to walking.   Hooping places milder stresses on the knee, ankle and foot joints than walking so might be attractive for people who prefer a true low impact exercise.   It is a great compliment to traditional abdominal workouts by toning abdominal muscles, the muscle of the hips and adding curves to the waistline.

       According to research conducted by Consumer Reports, hooping for 5 or 10 minutes at a time is categorized as brief bursts of activity or harder exercise intervals that can help you meet the new, more-demanding federal exercise guidelines. It’s more than standing in a room swinging a ring of plastic around your hips; the hoop can also travel the arms, legs and torso and may include jumps and tosses should you be so inclined. It’s great for the abdomen, but the rest of the body benefits as well.

 

 

Your hoop should stand about 1" above your belly button.

 

    There is an emotional benefit to hooping as an adult. For most hoopers there is a surge in endorphins promoting in a natural chemical way a sense of well-being. Endorphins also provide a natural analgesic further enhancing the benefits achieved. Hoops used by adults to enhance fitness are larger ( greater than 36” diameters) so that they will rotate more slowly around the body. They are heavier than a child size hoop and have friction tape or a sticky foam to make them cling to the body instead of sliding down around the user’s ankles. It is actually easier to hoop as an adult than many found it as a child, because adults have more strength.

You Should Not Limp.

   Touted as an excellent form of exercise, walking is something we all do, and that most of us take for granted as an activity we need no training in. But of course we were trained, it was just at a time we no longer remember. 

    More than an exercise, it is a basic activity of daily living. We bear weight, we transport and we maintain our body’s equilibrium. The human gait cycle is more complicated than most of us appreciate, but perhaps that is because few of us take time to think about it. A normal gait supports our weight as we move with minimal energy expenditure. The lower limbs are adapted for stability rather than range of motion and that stability is achieved at the major joints of the lower limb through the use of strong ligaments and tight fitting bony surfaces rather than the expenditure of energy in the form of muscle contraction. 

 

 

 

 

 

 

 

 With each step we shift our weight to an ideal position supported by the surfaces of our bony joints. 

 

 

 

 

 

 

 

 The wide surfaces of the knee joints, and the arches of the foot and ankle bear the majority of the weight. The ligaments stabilize the joints with amazing strength providing support. The goal is to maintain an ideal center of gravity, and this is done instinctually. 

 

     The two main phases of gait are named stance and swing and the structures of the lower limb move differently during each. In stance phase the limb is weight bearing and in swing phase the limb is non-weight bearing. During stance phase, the pelvis moves over the thigh (femur), the thigh moves over the lower leg (tibia) and the lower leg moves over the foot. During swing phase, the motion is opposite, ie the thigh moves under the pelvis etc. 

 

     The muscles act to control the rate of motion and the size of each step. They accelerate and decelerate the bones to maintain the ideal center of gravity and support our weight as we move. Any deviation away from the instinctual pattern increases the work each limb must do at a higher energy expenditure. 

 

    If a muscle is weak, a ligament damaged, a bone misshapen or in the presence of neurologic disease, we subconsciously adjust our gait pattern to accommodate the dysfunctional part. Said another way, we limp. Most people think that if they have an injury limping will protect the impaired body part from further strain and this may be true but consider the rest of the body. For example, if an ankle is sprained, the normal compensatory instinct is to walk on the ball of the affected foot minimizing motion across the ankle joint. But walking on the ball of the foot, eliminating the part of gait when the heel hits the floor, causes excess strain on the calf muscles and hip, knee and toe joints and their ligaments. The time for each step on the injured leg is reduced and the healthy limb must bear weight longer than normal, thus straining the muscles and joints. And the muscles we do not use by walking on the ball of the foot get weaker.

    
   When we limp, protecting the one injured part, we cause strain and misuse of many other portions of each limb. And this strain and misuse happen all the time, with every step. The risks of limping to the entire limb far outweigh any benefit limping might offer a single injured portion of a limb. The damage begins almost immediately so that even a single day of limping may cause substantial injury. When injured it is essential that we adjust the way we walk to maintain a normal gait pattern. Reducing the speed of our walking is one efficient way to restore a normal gait pattern. When this is not enough, using a cane or crutch to reduce our body weight can restore gait to normal.

Athletes' Heart A Benign Syndrome

 

The heart is comprised of cardiac muscle fibers, which differ from the skeletal muscle fibers of the limbs or the smooth muscle fibers of the internal organs. The specialized muscles fibers allow the heart to function as a reliable pacemaker that proves remarkably accurate and strong.
Heart muscle develops as an athlete trains. The changes in cardiac muscle fibers, and heart function as a result of training do not parallel those changes seen in the skeletal system exactly. There are a collection of fairly typical changes that occur that have been named as a clinical syndrome called Athlete’s Heart. Athlete’s Heart is an asymptomatic condition associated with common clinical signs including bradycardia (slow heart rate), a systolic murmur and extra heart sounds that, in an athlete, are usually considered acceptably normal. The vigorous, repetitive training regimens that athletes routinely endure lead to characteristic physiologic and anatomic changes, including enhanced diastolic function, larger left ventricular dimensions and mass, and right ventricular dilatation and systolic dysfunction. These are all basically enlargements of the heart chambers or thickenings of the muscular chamber walls.

Normal Heart

Athlete's Heart

 These changes allow the heart to beat less to pump out the same or greater amounts of blood to surrounding tissues used in exercise. In the first six to 12 weeks of training, the resting heart rate decreases by five to 10 percent. The resting heart rate slows, a sign that the heart is pumping blood with greater efficiency. The large volume of blood flowing through the heart results in a slower, stronger pulse (which can be felt at the wrist and elsewhere on the body) and sometimes heard as a heart murmur. These murmurs, which are specific sounds created as blood flows through the valves of the heart, are no dangerous. The heartbeat of a person with athletic heart syndrome may be irregular at rest but becomes regular when exercise begins. Premature heartbeats may occur occasionally at rest. Blood pressure is virtually the same as in any other healthy person. The myocardial changes that characterize an athlete’s heart are influenced by the type of sport practiced. The physiologic responses to static and dynamic training lead to different adaptations to sustain the specific compulsory demand During aerobic exercise, the consistent exposure of the left ventricle of the heart to increased volume during episodes of sustained elevation in cardiac output causes the ventricular enlargement. Increased afterload during strength and weight training has a propensity to initiate ventricular wall thickening.

Calf Pain When Stepping

 

Many runners use the elliptical or arc trainers as alternative exercise choices when they are rehabilitating injuries. The indoor training apparatuses allow challenging aerobic workouts without the same potentially harmful physical impact experienced when running. But outdoor runners are practiced at using a normal running “gait” pattern than their colleagues who usually exercise indoors on treadmills, ellipticals and arc trainers. Thousands of people have climbed onto trainers without any “training” in their proper use. Treadmills, ellipticals and arc trainers do not come equipped with instructions attached to each machine as to how your feet should move. Though the physiologic effects of indoor cardio workouts may be very similar to running, the actual leg motions vary in specific ways, dictated by the aparatus being used. With ellipticals and arc trainers, the foot patterns are obviously different from outdoor running since the feet rarely rise off the footplates. Calf fatigue or pain or tingling during a aerobic exercise session on a treadmill or elliptical trainer are common complaints. These specific symptoms result from the way people use their legs when exercising on the machines compared with when they run or walk on the ground.

Normal gait

Running gait

 Usually with walking or running the foot lands on the heel (heel strike) and rolls forward. When you walk faster, your stride length (the length of each step) naturally increases. Your leg muscles prime themselves to extend further and your heels reach farther to take that longer step. This cannot happen natrually on a treadmill or elliptical machine where the distance available for the next step is fixed. Your foot hits the ground prematurely, landing on the ball of the foot instead of the heel, unless you make a conscious effort to place the heel first. With practice the you can and should use the more normal heel strike pattern. Repeated stepping on the ball of the foot will exercise predominantly the calf muscles, the gastrocnemius and soleus muscles, instead of the larger and stronger thigh and buttock muscles (hamstring, quadriceps and gluteal muscles). The calf muscles fatigue quickly and cramp. Lactic acid builds up and you feel painful tightness and resistance as the muscles fight against the work you are asking them to do. Essentially, it is as if you are walking or running on your toes. You want to make sure your weight is firmly on the heel of your foot when you begin stepping down on a leg. This places your body weight properly with your center of gravity more posterior and will use you muscles and energy more efficiently.

An Effective Cardiac Workout

 

As a muscle, a heart needs exercise to remain in conditioned. Exercise helps improve heart health, and can even reverse some heart disease risk factors. As a result of exercise, a heart can pump more blood through the body with every beat and continue working at maximum level, if needed, with less strain. The resting heart rate of those who exercise is slower, because less effort is needed to pump blood.

Exercise benefits the heart and circulation (blood flow throughout the body) by improving cholesterol and fat levels, reducing inflammation in the arteries and helping to keep blood vessels flexible and open. For the greatest heart protection, it is not the duration of a single exercise session that counts but the total weekly amount of energy expended. The American Heart Association recommends that individuals perform moderately-intense exercise for at least 30 minutes on most days of the week (2008 recommendations - now recently updated in 2018 to greater than 150 minutes weekly). Similar exercise guidelines have been issued by the Centers for Disease Control and Prevention, and the American College of Sports Medicine (30-60 minutes 3-5 days/week). These organizations are recommending aerobic exercise, but resistance (weight) training has also been associated with heart protection. It may offer a complementary benefit to aerobics. And studies show that yoga and tai chi, an ancient Chinese exercise involving slow, relaxing movements, may lower blood pressure almost as well as moderate-intensity aerobic exercises. So know that there are options when designing your ideal exercise program.
 
     Consider the logic of this concept, that for optimal cardiac conditioning, creating a routine combining low intensity aerobic, moderate intensity aerobic and resistance training sessions each week provides the most functionally relevant conditioning. The benefits of such a program affords us with a heart that is well equipped to deal with any and all forms of stressors we encounter in our daily activities. Ultimately, this is what we are training our hearts to do.

     With any exercise program safety is an issue. To reduce the risk of injury or complications and make exercise more enjoyable there are a few things we must all do (or at least consider doing if we develop any possible risks). If over 40 years old it is recommended that you speak to a doctor first before starting any new exercise program. Chose a type of exercise you are more likely to stay with over the long-term. Perform your activity at a level in which you can carry on a conversation while exercising. This "talk test" provides a general rule of thumb to help you determine if a particular activity is too strenuous for you (the proper intensity of your workout).
 
     The specific design of an individual exercise program depends on the person, their age, level of fitness, basic health and personal interests. Doing something is proven better than doing nothing at all, so no one should abandon all exercise if they feel they cannot meet suggested guidelines. Knowing the guidelines provides a target for educated structure. Use these to create a program you can enjoy. Run, dance, walk, lift weights, and plan these activities with friends or alone, in a gym, in a park, at a nightclub or at home. Be creative, but be active.