What is balance?
Balance is often associated with stability, safety, confidence and control. In any context, it is related to equilibrium - in humans, this can be emotionally, mentally, financially, socially, ethically and physically.
In physiotherapy, balance is defined as an individual’s ability to control their centre of gravity within a limited base of support. Balance involves a complex set of sensorimotor control systems that include sensory input from vision (sight), proprioception (joint position) and the vestibular system (motion, equilibrium, spatial orientation); integration of that sensory input and motor output to the eye and body muscles. Injury, disease, certain drugs, or the aging process can affect one or more of these components. In addition to the contribution of sensory information, there may also be psychological factors that impair our sense of balance.
Why is balance important?
Balance is an essential component of human function; without it, we would be unable to manage our daily tasks safely and effectively. Imagine trying to complete your usual daily tasks with impaired balance, for example, standing up from a chair and walking to your front door to pick up a letter from the doormat. Effective balance can help to maintain or improve:
Posture
Strength
Coordination
Speed of motor response (e.g. tripping and staying upright)
Walking speed
Proprioception (awareness of your body in space)
Confidence
Risk of falls
Injury prevention
Quality of life
The Biology of Balance
Since there are multiple complex systems involved in maintaining balance, we may experience balance challenges if any of these components are impacted.
Normal ageing will contribute to general difficulties in balance, particularly due to deconditioning of the sensorimotor control systems, such as vision and proprioception. Neurovascular issues affecting nerves and circulation may cause altered sensation or numbness that may impair confidence and balance.
In addition, general loss of muscle strength may contribute to unsteadiness. Specific musculoskeletal concerns, such as loss of range of movement, pain and injury may impact stability, for example, ankle, knee or hip pain.
Cognition can also create challenges with maintaining balance, for example chemotherapy-related cognitive impairment (“chemo brain”) can slow the processing of information and decision-making which may increase risk of tripping and falling.
How can cancer impact balance?
Depending on the location of the cancer itself, balance may be affected, for example, disease found in the brain, spine, eyes and limbs. Cancer may also have a secondary impact on balance, for example, low blood counts, low blood pressure and dizziness.
Cancer treatments may also cause issues with balance.
Radiotherapy close to the head, neck or spine, may cause inflammation around the nervous structures, resulting in dizziness, pain or stiffness which causes difficulty turning head or issues within the vestibular system.
Chemotherapy could cause fatigue, cognitive changes and/or peripheral neuropathy that can impact sensation, impair balance regulation and slow down reactivity. It may also cause loss of muscle mass and strength, which can impact postural stability and increase risk of trips or loss of balance.
Surgery may cause a temporary change to balance due to weakness, lack of energy and pain impacting reactivity of balance pathways. It may also cause long-term changes if nerves are significantly damaged or removed during the surgical procedure.
It is therefore very important during cancer treatment, to be mindful of your balance and to proactively practice balance exercise to prevent issues.
How can I improve my balance?
Finding safe ways to challenge and improve your balance is important; it is one of the four recommended types of exercise: strength, aerobic, flexibility and balance.
The recommendation is to integrate 2-3 sessions of balance practice into your weekly routine. These could be a specific home programme or can be associated with an activity such as yoga, dance, pilates, QiGong or Tai Chi.
Please feel free to give these below exercises a try to challenge your foundations!
Stand with feet apart for 1 minute
Stand with feet together for 1 minute
Tandem stand with heel touching toes for 30 seconds (both sides!)
Tandem walk with heel touching toes for 10 steps or 3m (forwards and backwards!)
Heel raises, coming high onto your toes and slowly lowering down.
One leg stand
One leg stand around the clock, tapping opposite toes to each hour of the clock.
You can add variations to the above exercises by keeping your eyes open, closing your eyes, turning your head from side-to-side slowly or quickly, adding a dynamic activity for example tossing a ball, reaching out of your base of support, picking an object off floor, practicing an overhead activity, moving your opposite leg, adding an unstable surface underfoot and many more!
Other positions you can practice more advanced balance in, include four point kneeling or upper limb weight-bearing positions, such as:
Bird-dogs
Shoulder taps in plank
Side plank
Heel raise squats
Crow pose (Kakasana)
Headstands
Please check with your medical team if you are aware of any reason you should not practice the above exercises. If you have impaired balance, it is important to ensure you have a stable surface and supervision from a loved one or professional while you practice your balance exercises. If you would like more advice with a personalised balance programme, please do not hesitate to get in touch with me for a 1:1 physiotherapy session (hannah@strongerthan.co.uk).
Comments