Home Newsletters What Really Constitutes Functional Balance Training?

What Really Constitutes Functional Balance Training?

Written on February 1, 2009 at 2:05 pm, by Eric Cressey

Just a few days ago, a friend of mine passed along the link for a Reuters article reporting on a study that found that a 12-week Tai Chi intervention did not reduce the risk of falls in the elderly.

This might be surprising to some, as one would think that any sort of physical activity would benefit untrained elderly individuals.  However, I wasn’t surprised at the results at all, given all the research I’d done to prepare for The Truth About Unstable Surface Training.  And, I wasn’t surprised at all when I realized that this had significant parallels to how we train balancing proficiency in athletes.

It’s important to understand first and foremost that balance and proprioception (and, therefore, stability at a certain point in time) are skill-specific.  In particular, one must appreciate that static balance – which is typical of Tai Chi – is markedly difference from dynamic balance, which we encounter all the time in everyday life and in the world of athletics.

For proof, one mustn’t look any further than when Drowatzky and Zuccato (1966) found little carryover from static to dynamic balance (1).  Tsigilis et al. confirmed this finding 35 years later (2). And, it’s one reason why I feel so strongly that we have to qualify our unstable surface training (UST) recommendations.  UST necessitates a significant amount of static balance that may not transfer to sporting movements, which typically are more dependent on dynamic balancing proficiency.

From my e-book on the subject, “Previous research has demonstrated that scores on static balance tests are not useful information when attempting to predict inversion ankle injuries in soccer players (3). This lack of correlation implies that methods to improve static balance may not be effective training approaches to prevent injuries in dynamic sporting contexts – especially when dealing with athletes with no recent history of lower extremity injury.”

Now, we know that we can’t train complete specificity 100% of the time.  Otherwise, in the elderly, we’d be trying to simulate every kind of fall that is possible.  And, in a football player, for instance, we’d be trying to simulate every kind of tackle a running back could possibly encounter.  So, what do we do?  Once again, we look to the research!

In a study by Bruhn et al., a high-intensity strength training group actually outperformed the unstable surface training (static balance training) group on measures of static balance (4).  In other words, one group trained static balance, and the other didn’t – and the one who didn’t train static balance directly actually improved the most overall.  Maybe muscle cross-sectional area played into it?  Maybe it occurred because of increased stabilization via enhanced intra- and intermuscular coordination that would allow for more rapid and effective force production (strength and rate of force development)?  Maybe true specificity isn’t as important as we thought?

Click here to purchase The Truth About Unstable Surface Training.


References

1. DROWATZKY, J.N., AND F.C. ZUCCATO. Interrelationships between selected measures of static and dynamic balance. Res. Q. 38:(3) 509-510. 1966.

2. TSIGILIS, N., E. ZACHOPOULOU, T. MAVRIDIS. Evaluation of the specificity of selected dynamic balance tests. Percept Mot Skills. 92(3 Pt 1):827-33. 2001.

3. KONRADSEN, L. Factors Contributing to Chronic Ankle Instability: Kinesthesia and Joint Position Sense. J Athl Train. 37(4):381-385. 2002.

4. BRUHN, S., N. KULLMANN, AND A. GOLLHOFER. The effects of a sensorimotor training and a strength training on postural stabilisation, maximum isometric contraction and jump performance. Int J Sports Med. 25(1):56-60. 2004.

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  • Mike T Nelson

    Good stuff EC! You are right on that balance is VERY specific and has a poor positive transfer most of the time (esp lower body UST).

    I do actually think that teaching someone how to fall (in a progressive, controlled and safe manner of course) can be very useful since you are removing their biggest fear (esp older populations). Too much fear/threat is bad for performance.

    If I go take someone and teach them great sprint technique on day 1, then let a bear chase them—anything that they just learned will be dumped and their form will be less than stellar. The threat is too high at that time.

    Rock on
    Mike N

  • Robert

    Eric, I strongly agree with this article. I work with the elderly on a daily basis and have found that strength training in combination with dynamic balance drills have great carry over to improved balance and fall prevention. Our dynamic balance drills focus mainly on the ability to decelerate the body and effectively accelerate in a desired direction without losing posture(maintaining posture being the largest issue). Working on anti-rotation (as described by Mike Boyle) also seems to be greatly beneficial in this population. It seems many programs for the elderly incorporate alot of machine work and very low level movements, such as 1 lb bicep curls in a chair. I do not use machines, incorporate lower reps, and focus on power development with an extremely heavy posture focus, and the results are very desireable.
    Thanks

  • Santiago

    hi

    how do you teach someone how to fall in a progresive manner?

    kind of rolls you do in aikido and things like that?

    I would love to do this with my flag football team

    guys have had some falls that I think could have been avoided with better body control

    thanx

  • I see this all the time with the seniors that I come across. Every winter, they want to train “for balance” becuase they are afraid of slipping on ice. I tell them that “you can have the best balance in the world, you are still going to slip on ice!”. Strength is what is needed, and if they can look past the “sobriety test” walks that they are taught in senior classes, maybe they will understand that strength will lead to better balance.

  • Andy Brice

    EC,I agree, balance training is very misunderstood and wrongly trained with too many static activities. Balance is dynamic activity and should be trained as such. Try using Gary Gray’s LE functional profile with balance and reach activites that are multiplanar. Balance is just one activity that needs to be enhanced to decrease risk of falls.

  • Strength increases stability! Stability increases balance. Many falls occur because there is not enough strength to overcome quick changes in balance. Research done years ago at ASU showed the best way to prevent falls in the elderly was to increase their strength levels. Strength training continues to get farther and farther from the basics.

  • Sending this to my grandma that’s been argueing w/ me forever.

    Maybe you can talk her out of dipshit dr.’s point of view.

    I agree!

  • If I remember correctly, In “New Rules of Lifting” by Alwyn Cosgrove, the functional attribute of “power” is most important when it comes to aging well.

    While “strength” work may not directly work on “power” if movements are completed slower, the ability to recruit muscles quickly that defines “power” will still go up.

    When a fall is likely, the person who doesn’t fall is the one who can catch himself fastest.

  • Shawn

    I would like to defend Taiji a little here. If someone is only doing non-martial Taiji slowly and gracefully then little is gained in any area. But actual agressive martial Taijiquan can do wonders for balance and coordination. Mainly, because one is being hit while staying stable, stiking without giving up stability, and manuevering quickly while twisting, turing, rotating, shifting, etc. All while hitting and being hit. So don’t judge Taiji if all that is being done is a slow form.

  • Several years ago I attended a bosu training weekend with Doug Brooks. He told the attendees that standing on the flat surface of the balance trainer was so unstable that even he was not allowed to train his snowboarders on that side. Consequently, I do not allow it in my studio. You have a picture of someone performing this activity. Is the risk worth the reward? If so, what population would benefit?

  • Jason

    Thus is derived the new definition of BOSU:
    Better
    Off
    Standing
    Upright

  • John Grogan

    I use dynamic escalation of balance training coupled with partnered reaction drills which has improved balance by restoring confidence and ability through mobility. I also use integrated functional matrix which challenge the mind to learn new movement patterns in progressive endurance training using various equipment. Improving sphere of function preceeds fitness training because if you can’t move well, it doesn’t matter how fit you are. All my clients have improved balance, co-ordination and mobility on my program. Strength training without correct preparation is misguided, without correct physiological foundation and it is isolationist in application whereas balance is dynamic integrated movement. Humans move in a controlled fall all our lives. Static strength training does nothing for balance. Rant over!

  • Great article, and comments. What is “static strength training?”

  • Mark

    This comment is unrelated to the post above, I apologies: what are your thoughts on CrossFit. Our high school football team is 2 months into CrossFit training for next season. All I see is exercises being done as fast as possible with no focus on form. Everything has to do with how many reps can you do in a set amount of time.
    Respectfully,
    Mark

  • Hi Eric-
    I appreciate your work on this front (as well as all of your other thoughtful posts), especially because you point out how balance is “skill-specific.” The balance required to do a squat and lunge are very different because the former is a body stability exercise whereas the latter is body transport (the center of gravity moves beyond the base of support). In “real-world” situations of athletics and locomotion, we primarily do body transport activities and yet the majority of movements in the gym emphasize body stability (squats, DLs, presses, rows). To maximize transfer, we should try to make these skills more specific to the demands of the goal activities.

  • Functional balance in different populations needs different empahsis
    In working with older clients that have becomed stiff and deconditioned, trying to work first on balance is inappropriate. Evaluations will often show very stiff trunk and limbs–so that they easily move their center of gravity farther to the edge or beyond the edge of their base of support. They need to develop some basic articulations in the trunk and lower extremities. Then they need to to develop some basic trunk control–most of them cannot even roll over in bed well.
    The list of preparation goes on
    I actually see this in many populations who are working on “functional balance” way too early without addressing these preliminary components sufficiently.

  • Eric,

    Just wanted to start by saying keep up the great work. I would like to get your thoughts, however, on an article that directly relates to this blog post entitled, “The effectiveness of a balance training intervention on reducing the incidence of non-contact ankle sprains in high school football players.” This article appeared in the Aug issue of the 2007 American Journal of Sports Medicine. The authors specifically found that by simply adding single leg balance on a foam stability pad to their training program that there was a 77% reduction in the incidence on ankle sprains in a high risk group of athletes. These findings are quite impressive and the researchers also went on to win the excellence in research award from the sports physical therapy section of the APTA. These findings seem to contradict one of the points you made in the blog post, “…methods to improve static balance may not be effective training approaches to prevent injuries in dynamic sporting contexts.” Im not looking to be difficult but I was impressed with the outcome of this study though I also value your perspective. Hope you are well otherwise!!! I also really enjoyed the functional stability preview that you and Mike did…good stuff! Look forward to hearing from you.

    Regards
    Chris

  • Glynn Loeb

    Good stuff! One of my clients started working out last year at the age of 80…balance was and is still a major focus for us. In fact, she taught me something! Stepping down (like from a curb) is more of a concern to her than stepping up! So, we’ve simulated that move in the gym (using steps) and I’ve been able to progress her as her core and lower extremity strength have improved!

  • Chris,

    The issue here is that by looking at the high-risk group, they aren’t separating out those who may have insufficiently rehabbed previous ankle injuries. Basically, that “high-risk” group wouldn’t qualify as “healthy” because of their proprioceptive deficits (functional ankle instability). This is something that has been HEAVILY controlled in previous research (mine included). We just don’t know if we are reducing injuries in those who don’t have existing proprioceptive deficits from previous lower-extremity injuries.

    Great comment/question!


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