Balance is an important system of our body so it is something that as Pilates Movement practitioners we are constantly incorporating into our clients’ programs to support their quality of life. At times I see people confuse balance and agility and not appreciate that, whilst the concepts are related, they are different and both should be considered in our programming with clients of any ages.
Watch an exercise using our newest product, Pebble and Pod called the Princess and the Pea:
What is agility?
Agility can be used to describe mind and body and both are important for quality of life. Sheppard and Young (2006) defined agility from the perspective of sports as a “rapid whole body movement with change of direction or velocity in response to a stimulus”. However, for the average person a broader definition would be the ability to quickly change and respond the body’s position to the environment.
For many of my clients, agility is more about the ability to recover from tripping on a tree root, the edge of a footpath or an e-scooter whizzing past you when you are trying to carry the shopping. To be able to stay upright requires a person to integrate balance, coordination, speed, reflexes, strength and endurance.
The broad system of balance is the ability to maintain equilibrium when stationary or moving (i.e., not to fall over) through the coordinated actions of our sensory functions (eyes, ears and proprioceptive organs in our joints). These various systems are integrated mainly in our cerebellum to create balance.
The specific skills of static and dynamic balance are:
- Static balance – The ability to retain the center of mass above the base of support in a stationary position;
- Dynamic balance – The ability to maintain balance with body movement; an equal distribution of weight;
- Speed – The ability to move all or part of the body quickly;
- Strength – The ability of a muscle or muscle group to overcome a resistance;
- Coordination – The ability to control the movement of the body in co-operation with the body’s sensory functions (e.g. in catching a ball using ball, hand and eye coordination).
It is important to remember that each of these skills/systems need to be trained independently for achievement of each level and then overlaid to be integrated into the state of agility.
In a series of articles I will explore ways that we can train each of these skills in a movement class and how we then work to incorporate these to achieve agility.
I will start this series by updating an article I wrote and shared in 2019 in which we focus on the balance systems. In subsequent articles I will explore static and dynamic balance, speed , strength and coordination.
Balance Senses and Systems Include:
The balance system in our body incorporates three major senses, namely:
- Visual – what we are seeing;
- Proprioception – where we are in space and how to maintain posture in relation to gravity;
- Vestibular – how our head is sitting in space and our head righting response in relation to gravity.
All of these senses feed back to part of our brain called the cerebellum. To learn more about it you can try our online Introduction to Neuroanatomy course, which explains many of the neurological terms and concepts that you will read in this article. The cerebellum is situated at the back of our head and is essentially the coordination or headquarters for all of the sensory information about where we are in space, and what we are seeing. The cerebellum coordinates our motor responses that stop us from falling.
Remember, there are three major systems of the body when it comes to the balance systems:
- Sensory systems – visual, proprioception, vestibular;
- Processing systems – cerebellum and other major nerve control systems;
- Skeletal & muscular systems – which are needed to respond and move. Your eyes have muscles as well, so even they need to be trained just as much as the muscles of the legs etc.
All three of these systems need to be considered and focused on when you are working with clients – just lifting weights is not enough. An understanding of the cognitive processes that are called upon in Pilates and Gyrotonic classes is essential to appreciate why these classes are so effective in helping with balance outcomes.
The Visual System, what is it?
The visual system is constantly adjusting to make sure our eyes don’t blur when we move our head. The eyes can stay fixed on a spot and focused when we move the head, which is important when we are doing multiple things. This ability is attributable to the Vestibular Ocular Reflex (VOR).
Try this little test to understand the Vestibular Ocular Reflex:
- Write your name on a piece of paper;
- Look at the piece of paper and move it rapidly whilst keeping your head still and eyes fixed on your name;
- Now keep the paper still and keep your eyes fixed on your name whilst you turn your head from side to side.
The eyes see things in space so we don’t trip over them. This can become a bit of a problem for people with glasses or cataracts, as their peripheral vision can become affected, potentially resulting in trips or bruises on their sides. I have to admit I have a very high level of myopia and am constantly tripping on things. This loss of vision in our peripheries can become an issue as we get older, as cataracts are quite common. Remember also that cataracts are a common side effect of medications such as glucocorticoids – often used to treat inflammatory conditions like asthma (in Australia 12% of the population has Asthma), or Rheumatoid Arthritis (in Australia about 2-3% of the population have this condition).
If you don’t have poor vision, try putting your hands up to the sides of your eyes, as if you have horse blinkers on. Now just walk around and note how clumsy you have become.
Some ideas that can be incorporated into a Pilates class include:
//Closing the eyes when doing some standing or walking exercises.
// Having the person do pivot work whilst they are looking into a dark corner, and have them pivot to a light part of the room. The idea being to train people to have faster adjustment of their eyes. Remember many falls occur at dawn and dusk or when a person moves from a dark room to a light room.
// Not using terms like fix your eyes on a spot, to help you balance. I know I hear this term often from yoga teachers and while this cue is great for a temporary balance it can create over reliance on the visual system for balance, which can then lead to problems when we can’t rely on our eyes, e.g. when we are needing to adjust our eyes. The lesson from this is to constantly keep the movement cues varied and appropriate so that you are not creating new compensatory patterns.
// Some ideas would be to incorporate eye disassociation exercises into your class, e.g. the head series on the CoreAlign or Jump Stretch Board. There are some great ideas that are used in the Feldenkrais method as part of the sensory awareness training for the eyes.
In this series we use the wunda chair to support a seated squat. We then add the MAKARLU Pebble counterbalance pod on a stick to help create a visual focus. This is then progressed as a vestibular challenge as you turn to follow the objects.We progress this to a standing version.
The Proprioceptive System, what is it?
The proprioceptive system is essentially the sensory information in our joints that feedback to the muscles telling us where we are in space. This is where Pilates and Gyrotonic teachers come into their own when working with clients. Our focus is about alignment and teaching a person about their relationship with space and gravity.
In a good movement class your teacher is constantly asking you “how does that feel?” I know I will make clients walk around after certain exercises or activities in order to refocus their awareness to what is happening and what they are feeling. This is part of the process of teaching and integrating movement and the proprioceptive system into better overall balance systems. It is one of the reasons that all of the Pilates teachers who work for Body Organics or who are trained by us are encouraged to work in small semi-private arrangements with our clients. This process allows us to help clients change their behaviour and create a new relationship with their body. Pilates and Gyrotonic are not simply exercises, they are movement systems aimed at improving the quality of life and experience of a client, not just about looking good for summer!
When working with people on the equipment I like to ensure that at first there is a closed loop system – i.e. the joints are pressing into a bar or a wall. This is what allows the joints to get feedback about where they are in space. The chain can be slowly opened to help build awareness and control when they are moving around in the world.
Experiential Anatomy
Open chain – If you are not sure what I mean, put your arm out to the side, feel where it is, and think about what is happening in your shoulder
Closed chain – Now put your arm out and press the hand out into the desk or a wall. Can you sense your shoulder organisation a little bit more? Is it easier to feel how the arm and shoulder are linked?
When you look around a good movement studio you will notice that the equipment has capacity to perform closed chain activities. The teacher will generally start you with the joint organisation so that the muscle recruitment and the messages back to the cerebellum about the proprioceptive system can be clear. It is then easier for a client to build an understanding of their bodies orientation and how to organise themselves.
The Vestibular System, what is it?
- The vestibular system, which is partially embedded in our middle ear, is the snail like image above. The rest of the system is linked to nerves and processing sites in our brain, however let’s start with the middle ear components, which include:
- The semi-circular canals – one set in each ear with different orientations to detect a variety of movements such as nodding or rotating. Movement of fluid inside the canals caused by head movement stimulates tiny hairs that send messages via the vestibular nerve to the cerebellum.
- Two otolith organs (called the saccule and utricle) send messages to the brain about body movement in a straight line (backwards/forwards or upwards/downwards) and also about where the head is in relation to gravity (such as tilting, leaning or lying down). These organs contain small crystals that are displaced during these movements to stimulate tiny hairs, which transmit the message via the vestibular nerve to the cerebellum.
So, what do all of these vestibular concepts mean when I am moving?
Essentially when you move your head, either the hairs in your ears or the crystals will help you adjust your posture so that you do not fall down! If you get dizzy or nauseous when you move your head, this will give you an idea that some of these systems are not working optimally. This is what the doctor or the physiotherapist/osteopath/chiropractor is testing when they ask you to move your head in certain directions.
- For example:
- Move your head as if saying yes or no. In those movements you are moving the fluid in your head and triggering the little hairs, so you can imagine that when you are in a movement class exercises like chest lift and chest pull on the reformer could trigger a vestibular response (sometimes not always good)
- Moving your head in the spirals as on the Gyrotonic apparatus – this can trigger some of the otolithic crystals
Balance and Vestibular Ideas
Progressions of exercises are quite possible when you are working with a well trained movement teacher. It is important to remember that when training in these disciplines the teacher undertakes thousands of hours training and observing people in dynamic activities. A well trained movement teacher is able to quickly modify and tweak your activities to provide the sorts of functional balance work needed to keep a person engaged and challenged – week in, week out.
I enjoy using many of the traditional Pilates equipment to help with balance, as well as CoreAlign, Gyrotonic and Makarlu Lotus, all of which add dimensions and variety to clients programs.
Some of my favourite ways to build on balance challenges and engagement in the studio are:
Example 1: Reformer Work
- Reformer work
- 4 point kneeling on the floor, or wall elephant
- Knee stretch on the reformer +/- eyes fixed, eyes moving from side to side from hand to hand, moving the head (VOR stimulation)
- Twist knee stretch on the reformer (challenging the otolithic organs in the vestibular system)
- Down stretch on the reformer with the eyes moving up and down (in the same or opposite directions to the body as the body swings back and forward on the reformer)
Pebble scooter challenge to increase the dynamic stability response. I like to use the lotus under the ankle or in various feet positions to support the ankle alignment. I then progress the exercise to add in rotation to challenge the vestibular system and postural control.
Example : Walking and Postural challenges
Balance beam
// Walking back and forward on the timber floor. To challenge, add a softer surface for the person to walk along, such as a mat or balance beam
// Walking along the beam. To challenge, add nodding the head up and down or turning the head from left to right (challenging the vestibular semicircular canals), or move the head from side to side so that the ear goes to the shoulder (challenging the otolithic organs in the vestibular system)
// Walk along the floor in a straight line with eyes closed
the person on the floor with a hard surface to walk on)To achieve agility I would then progress this to have the person standing on different surfaces to challenge postural response and speed.
Step one both feet on a wobble surface- I use Pebble board and pod with Makarlu Lotus or Coast. The surface is stable but the underpinning is wobbly. This supports the person’s feedback systems to get proprioceptive organisation in the feet whilst working on dynamic stability
Step Two – Change the feedback on each foot, so that the body is having to achieve dynamic stability and respond to the different surfaces whilst remaining upright.
Step three have the person standing upright on one foot. First of all just on the floor ( static stability) then add the challenge on an unstable surface. I like the pebble pod arrangement as the surface is stable for input. Then have the person standing on the surface doing dynamic stability challenges eg catching a ball or changing direction. I like the courtsey example below as the person has to change directions and cross the midline whilst staying upright
Progress the challenge by making the surface wobblier.
Safety Precautions for balance and falls
It is important to remember that dizziness and vestibular conditions can be a consequence of significant medical problems e.g. multiple sclerosis, stroke or Parkinson’s Disease. I recall a time with a particular client when I had noticed a deterioration in her gait pattern over the course of a month or so. She also seemed to be constantly dizzy, so I insisted that she go to a doctor. I told her that I would not allow her at the studio until she had done so, so she started going to a different practice. Two months later she rang to let me know that I had been correct in my concern. She had been experiencing a brain bleed and was having surgery to have a shunt placed in her brain. She had not wanted to go to the doctor because of a family history of Parkinson’s disease which meant that she was understandably concerned and did not want to confront the issue. It seemed that her existing Pilates teachers had observed changes in her that the new practice had not detected or thought to act on. The moral of the story is, if you observe unusual gait or movement changes in a client, find ways to help them follow up and check on these issues.
Some tips for teachers:
// Remember that conditions like drop foot can increase a person’s risk of falling, so it’s good to incorporate exercises for feet into your movement class. Some ideas for working with drop foot can be found in this article.
// Balance practice should be done near a wall or a place in which a person has support structures to grab onto for safety if needed
// Make sure steps and trip hazards are clearly marked or minimised
// Don’t place someone into an unsafe position like standing on a reformer, bosu, or balancing with heavy weights, unless there is appropriate support in place and it is suitable for the person’s ability
// Know the signs of stroke
// Make sure you have clients follow up with their doctor if they are having repeated concerns about vestibular or balance issues
Carla making sure Manuel is not going to fall when he is doing balance exercises
Remember when working with clients it is more than just “muscular strength” that we are working with, it is also about neural responsiveness. Furthermore, it is important for your clients to know that your focus is ultimately their overall quality of life. This quality of life comes from good movement patterns and their ability to continue to engage in the world around them. If you can work together as a team in which your client owns responsibility for their health, then you are part of the way towards achieving a great outcome.
For those interested in some of the practical ways of incorporating agility into your practice:
// This will be one of the topics covered in the Makarlu Masterclass on Friday 9 August in Brisbane. This masterclass can be accessed by zoom and the recording can be purchased later.
// Chucking a wobbly is a great online course about training balance
References
M. Sheppard; W.B. Young (September 2006), “Agility literature review: classifications, training and testing”, Journal of Sports Sciences, 24