Consider adding this to your exercise routine today. Slip into a set of worn-out boots or running shoes, preferably ones with no discernible tread remaining. Find a compliant partner or a large dog that loves to attack squirrels to assist you. Select a convenient patch of slippery ice, ideally located on a slight incline like Fonthill’s Haist Street sidewalks or Sunset Drive in Fenwick. Stand on the ice or walk across it slowly with your eyes closed— and wait.
Your partner’s role is to give you a firm, quick and unexpected shove, or an instantaneous jerk of their leash in the case of the dog, while you’re on the ice. The milliseconds that you fight for balance just before a) falling backwards on your head, b) dropping like a stone on your butt, or c) shuffle-dancing like a Zaouli warrior and regaining your balance, are called Perturbation Balance Training (PBT).
PBT is a fresh discipline in balance training, and very different than the common standbys, Fall Prevention and Balance Training (BT). Importantly, PBT offers benefits to recreational athletes as well seniors and those with various neurological conditions.
Fall prevention strategies are necessary, and potentially reduce the risk of unexpected falls. However, in an active demographic like Pelham with so many walkers, pickleballers, runners, tennis players —add your sports passion to the list —stressing fall prevention is only half the solution.
Fall prevention is all the things we can do to reduce the risk of being in a situation where we’ll lose our balance, possibly resulting in a fall. Strategies are generally divided into two categories, maintaining good body health and making our personal environments safer.
Body health includes being aware of all the possible side effects of any medications we might take, staying active to help maintain strong bones, ligaments and muscles, providing better control of our movements, getting our eyes and ears checked regularly, and minimizing alcohol consumption.
Environmental fall prevention activities include wearing sensible shoes, removing household trip hazards, minimizing slippery conditions in bathrooms and kitchens, and using assist devices when advised.
Regardless of all these efforts, if we’re ambulatory, at some point we’re going to lose our balance. This is especially true for those of us who consider ourselves recreational athletes, and participate in activities that may reasonably be expected to frequently cause loss of balance.
If we look to the American College of Sports Medicine for guidance, they still suggest simple balance training to prevent sports falls. Traditional BT involves slow, almost static exercises and drills primarily based on strength training designed to improve our body’s ability to re-establish equilibrium.
A multi-authored study in the American Physical Therapy Association’s Rehabilitation Journal describes the act of falling in precise detail. “A specific fall event ultimately occurs when an individual fails to recover from a loss of balance or postural perturbation. Postural perturbations can occur in daily life for a variety of reasons, including failure to control weight shifting during voluntary movement or experiencing a slip or trip while walking.”
PBT, a newly emerging training regimen based on coping with repeated rapid balance disruptions, is all about preventing the “fails to recover” scenario, and goes a step further than simple PB. Interest in PBT is not limited to seniors, and is quickly becoming adopted by recreational athletes.
The key to not falling every time we lose our balance lies in our immediate reaction, in how well and how quickly our body and brain reacts to stabilize us. Studies and trials now indicate that balance recovery training in which we’re repeatedly and unexpectedly thrown off balance can improve these reflexes by forcing our body’s involuntary reactions to adopt better neuromotor skill coordination strategies.
The key is to avoid focusing your training on making voluntary recovery movements such as adjusting your foot position in a specific manner or trying to grasp a railing in the bathroom as you’re heading to the floor, but to improve the speed and stability-inducing reactions of your involuntary movements.
PBT stresses the speed of reaction rather than muscular strength. Moderate levels of muscular force applied very rapidly are now understood to be more successful in balance recovery than the slower voluntary reactions that BT emphasizes.
A University of Montana Trial states, “It has been demonstrated that with only a few PBT sessions, older adults make rapid and dramatic improvements in balance recovery performance, retain the skills long-term and potentially suffer fewer falls over extended periods.”
This is all good in theory, but how do we practice PTB in a safe manner? The “Find a piece of ice and ask someone to knock you on your ass” strategy outlined in the first two paragraphs of this column holds limited appeal for most of us. [Editor’s note: Please do not find a piece of ice and ask someone to knock you on your ass.]
It has been demonstrated that with only a few PBT sessions, older adults make rapid and dramatic improvements in balance recovery performance, retain the skills long-term and potentially suffer fewer falls over extended periods
For the purpose of trials and studies, subjects use specifically designed treadmills containing surfaces and obstacles mimicking those situations in our normal environments that cause slips and trips. Participants wear safety harnesses and elasticized support cables to cushion and/or prevent dangerous falls, and are wired to electronic equipment that monitors their body’s stabilizing activities.
This equipment is available to very few of us, and the costs are huge. There are, however, ways in which we can relatively safely engage in PBT exercises.
Maintaining our balance involves the inner ear, which provides our brains with positional information (vestibular sense), our vision, reflexes, and kinesthesia, our body’s ability to sense where our limbs are in space and how much force they’ll need to generate for a given movement. Anything that perturbs or disrupts these systems and causes us to lose our balance and begin to fall—then forces us to catch ourselves—may be a perturbation balance training technique.
Walking on a two-by-four, inches above your basement floor, heel-to-toe to replicate a balance beam or tightrope, is an example of PBT, as is balancing on a BOSU half-ball, or standing on one leg while brushing your teeth. For technology and equipment lovers, a Core-Tex Reactive Trainer with safety bar, to name just one example, also provides PBT. The nature of the exercise you attempt should vary depending on your current physical and mental capabilities, and whether you will attempt them alone or with a partner.
The results of PBT are startling. Avril Mansfield, associate professor of Physical Therapy at University of Toronto and a rehabilitation scientist, was the lead author of a 2014 study that found that one session of PBT involving healthy adults age 65-plus reduced participants’ fall risk by half.
A more recent, 2020 peer-reviewed study published in BMC Geriatrics found that falls caused by slipping amongst post-PBT participants were 72 percent less than a control group.
The Washington Post reported that in a similar 2020 study, PBT played a significant role in preventing older adults from experiencing major falls (as opposed to less serious falls) because it better-equipped those in the process of falling to at least partially recover their balance, resulting in a more controlled fall.
For recreational athletes participating in ball sports, the increased core muscle responsiveness PBT generated was found to reduce injury rates by nearly 50 percent when used as part of a regular warm-up routine.
After researching the benefits PBT offers when we’re forced to respond to unexpected balance loss while walking, jogging or participating in our favourite sport, there are definitely a few additional exercises I need to add to this evening’s routine. ◆
