Montana State University

Three easy steps to better balance

February 14, 2005 -- By Carol Flaherty

MSU Biomechanics Researcher Michael Hahn suggests that three exercises can help us maintain our physical balance: leg raises to the side, balancing on our toes, and raising our toes. MSU photo illustration by Erin Raley.   High-Res Available

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You're rushing to leave the house. You grab keys from the bedroom nightstand and gloves and coat from the hall closet. You close in on your travel mug in the kitchen, but the cat twines around your legs. You avoid stepping on the cat, but, in doing so, you fall flat.

If you're lucky, you're okay. Maybe you have strong bones or the coat cushioned your fall. It would have been better if your balance had been good enough that you didn't fall.

Balance isn't a matter of luck, says Michael Hahn, a Montana State University biomechanics researcher. Strengthening the main muscle groups that move your legs and help you balance is the first step toward avoiding falls.

"Research shows that loss of strength in the hips, knees and ankles has a lot to do with loss of balance," he says. Specifically, the muscles of most importance are those that lift your leg to the side, those that lift your toe, and those that keep you moving forward. It's important to keep those three muscle groups strong. The primary "abductor" that lifts the leg to the side is the gluteus medius (used in skating and skate-skiing). The primary toe lifter is the tibialis anterior on the shin, and the primary muscle for maintaining forward movement is the calf or gastrocnemius muscle.

"The head, trunk and arms are two-third of our whole body weight. With every step we take, all of that is held by the hip muscles of the standing leg. If they aren't strong, the person tilts to the side. If you slip and are already tilted, you are halfway toward a fall," Hahn says.

An easy way to exercise the abductor muscles of the upper thigh is to rest your hand on a chair or counter for balance, then lift the opposite leg out to the side. Hold it for a few seconds, then let it down slowly. Repeat the movement several times before doing the same exercise with the opposite leg. Increase the length of the hold as your muscles become stronger.

Stubbing your toe is another classic cause of falling, which makes it easy to understand why it is important to be able to lift your toe out of the way of low obstacles.

"You can exercise the front of your shin, mainly the tibialis anterior, by repeatedly flexing the toe up and down. You can do it while you're sitting on the couch, standing at the kitchen sink or waiting in a line. Just make sure you have a hand on something stable in case your body starts to shift to the side," Hahn says.

Forward momentum aids balance. That's why a two-wheeled bicycle can keep going forward when cruising along the street, but the rider often puts a foot on the ground to balance while waiting at a stoplight.

"The gastrocnemius, or calf muscle, provides a lot of our forward momentum," Hahn says. To exercise it, find a place where you can rest your hand for balance, then raise up onto the toes of both feet. Come back down slowly and repeat the process until the calf muscles are tired.

Oddly enough, Montanans seem to have unusually strong ankle muscles, Hahn says.

"I've measured senior citizens whose tibialis anterior is stronger than some young college students," he says. "I can only speculate that many people here are more used to walking on rugged terrain."

A lot of strengthening exercises focus on the knees to the exclusion of the hips and ankles, Hahn says. While acknowledging that the knees are important, he thinks the hips and ankles need more attention to maintain balance. Given the right exercises, balance can improve fairly quickly, he added.

Hahn also is interested in developing a set of predictive guidelines that health professionals could use to assess who is approaching a threshold of weakness that makes a fall likely.

"Usually exercises to strengthen the balance muscles don't get prescribed until after a fall. I think we can identify a threshold and prevent falls," Hahn says. He has a research grant proposal pending at the Centers for Disease Control and Prevention that would allow him to do just that.

If frequency of falling has anything to do with grant awards, Hahn has some powerful statistics to support his case. The American Academy of Family Physicians says that falling is the leading cause of injury-related visits to emergency rooms in the United States. Falls also are the primary cause of accidental death for people over age 65.

What Hahn hopes is that he'll soon be able to predict the likelihood of a fall so you don't have to have that one close call before you decide to build better balance. Right now, it takes a sophisticated lab to measure the whole body in motion and determine how well a person can balance. Using mathematical models borrowed from the field of artificial intelligence, Hahn hopes to provide simple measures that a clinician could use to get a measure of strength and the likelihood of a fall.

Between the cat and uneven or icy sidewalks, Hahn says "we call on our muscles to balance us hundreds of times a day. We can do something to help them answer."

Contact: Michael Hahn (406) 994-7154