I’ve been told that that the top part of this tall building has a giant water tower to give the building ballast and improved stability. It prevents the building from swaying too much in the wind. In the recent best-selling book Born to Run by Christopher McDougall, the author describes the work of Dan Lieberman, a Harvard theoretical researcher who has theorized that one of the key functions of the human head and its position above our neck is to provide ballast when running or walking. Since reading about this, I have been more observant of walkers and runners and how they use their heads. It is clear to me that the head does provide stability for these activities.

Dr. Lieberman believes this ballast is one important reason we humans are “born to run.” The question that has come to my mind is: What happens when the head is positioned out in front of the neck instead of directly on top of it? In this context, the “forward head posture” position would clearly be a major stability issue when it comes to balance, especially considering that the human head weighs about 20 pounds.

A simple but important balance exercise and posture correction exercise that can help prevent forward head posture is pictured here. By simply using one hand to “push up” your chest a little when standing and walking, you can “use your head” to achieve better balance and walking stability.

Kinesthetic awareness is the ability to know where your body parts are within time and space. It’s what allows a ballet troupe to move together, a skier to know where her body is in relation to her skis and the slope, and a baseball pitcher to coordinate his movements for a particular pitch. A natural athlete usually has finely tuned kinesthetic awareness. A “klutz” would have poor kinesthetic awareness.

Being mindful of and working to improve kinesthetic awareness results in improved balance, equilibrium, and quality of life. And importantly, it can prevent falls and injuries. Here are some simple ways to improve your kinesthetic awareness.

1. Make an effort to be familiar with your surroundings. If you are not familiar with your surroundings, slow your activities down and be extra careful. Many of the patients we see in physical therapy suffer falls and injuries when engaging in activities in unfamiliar suroundings.
2. Before engaging in new activities such as hiking and rock climbing, do practice activities that mimic your chosen activity, such as walking on uneven ground for hiking practice. Repetition of an activity improves kinesthetic awareness. We see many injuries as a result of people attempting a sport or activity for the first time without any practice. For example, first-time skaters and skiers are especially prone to injury.
3. Practice engaging in balance activities and exercises with your eyes closed. For example, stand on one leg with your eyes closed for 10 seconds or longer. Performing activities with your eyes closed will cause you to move slower and surer using your muscles to the maximum, and your kinesthetic awareness will improve.

Maintaining and improving kinesthetic awareness is especially important as we age. Being “kinesthetically aware” leads to improved equilibrium and balance, which results in a more confident and active lifestyle.

Have you ever felt unsteady, woozy, or had the sensation of spinning or floating? If so, you may have a disturbance of the vestibular system. The vestibular system is part of the inner ear that keeps objects in focus when your head is moving. It has specific functions that determine your physical orientation. The vestibular system interacts with your eyes, nerves, and joints to maintain your body position and orientation.

If a person sits in an enclosed cabin on a ship at sea, the person will see a stationary environment (the enclosed cabin), but the vestibular system will be measuring constant movement (the body rocking at sea). This conflict between the inner ear and the eyes causes motion sickness.

The vestibular system interacts with your nerves and joints to keep a person oriented. Vestibular disorders may have many causes and can impact your balance a lot. Specific exercises can help improve balance by compensating for some vestibular disorders.

As I’ve discussed earlier, balance problems can have many causes. The good news is balance exercises lead to system improvements (better balance), especially as we age. To learn more about balance disorders, check out the National Institute of Health website.

Have you ever lost your balance and fallen? Falls are a common cause of injuries, and these injuries can be life threatening—especially as we get older. Fall injuries commonly result in active people becoming inactive. Practicing mindfulness can help prevent falls.

Mindfulness is simply being aware of the ways we experience the sensory world, such as through our seeing, hearing, and touching. Mindfulness seeks to develop present-moment awareness and moment-to-moment attention. Practicing mindfulness when engaging in an activity such as hiking, walking, cycling, or running makes your activity more pleasant, and you’ll be more likely to prevent falls.

Your risk for a fall increases when you encounter obstacles to your present-moment mindfulness and you don’t take corrective action. Examples of obstacles to mindfulness include involved social interactions while cycling, walking fast over unfamiliar or uneven terrain while thinking about something that happened the day before, engaging in strenuous running during a stressful time, trying to keep up with a group that is walking faster than you are, or just walking while your mind is on autopilot.

Being mindful of these and similar situations and taking simple corrective actions to reduce risks may be all that is necessary to prevent falls.

For more information on the topic of mindfulness, see Frequently Asked Questions Regarding Mindfulness and Meditation by Jeff Brantley, MD.

Proprioception is an inner sense we have that allows us to know where a body part is without having to look. Nerves that send and receive information from tissue such as joints and muscles give us this inner sense. Good proprioception allows us to walk up stairs without looking at our feet or scratch our head without looking in a mirror.

Good propriocepton is needed for good balance and agility. If proprioception is diminished, problems with balance and loss of function result, which can lead to falls and other injuries. Joint surgeries, aging, inactivity, and illness can diminish joint proprioception.

Exercises that challenge your balance improve your proprioception. An example is standing on one leg for 30 seconds.

If this is challenging for you, then it is a good balance exercise for improving proprioception. If it does not challenge you, try doing it with your eyes closed. By doing this, you will experienced the importance of vision for good balance. I will talk about vision and balance next time.

Sadly, many patients I see in physical therapy for shoulder, wrist, hip, and ankle fractures are people who have taken bad falls. During the course of physical therapy, we frequently discover an underlying problem such as ankle and lower leg weakness. This weakness contributes to poor balance that in all likelihood contributed to the original fall in the first place.

In my last posting, I discussed how lower leg flexibility is an important component of good balance. Today I want to emphasize how important ankle strength is for maintaining good balance as well.

Can you stand on one foot and “pump” your ankle up and down several times without holding on, as in the illustration to the right? If not, you have weakness in your lower leg and your balance is not as good as it should be.

If you have lower leg weakness, you can practice improving your lower leg strength by doing the exercise with both legs, as shown in the illustration below.

If you need to hold on to something for practice, that is fine. Soon you will be able to do it without holding on, and then you could try doing it with one leg. When you first try these exercises, stand near a support structure or you may fall. And remember, no exercise should cause pain.

Do this calf stretching exercise before and after, and to determine how many times you should do this exercise, use this exertion index for guidance.

Have you ever noticed how flexible children’s joints are? Flexibility diminishes as we age, and tight muscles and joints contribute to poor balance. I prescribe this simple calf stretching exercise for many patients with tight ankles.

You can improve and maintain the flexibility in your ankles by holding this gentle stretch position for 30 seconds and doing it 4 times daily. Exercise should never cause pain, and you should not try doing this without permission from your medical provider if you have problems with your feet or legs.

I have provided the dimensions for the wedge if you would like to build one for home use.

Karen Moore, PTA at Milpitas Physical Therapy Clinic, is a guest contributor for today’s posting.

Ergonomics is the science of understanding the interactions among humans and the principles, data, and methods for optimizing human well-being and overall system performance while working.

Your chair needs to have good lumbar support. It’s most helpful if this lumbar support is adjustable. Most ergonomic chairs do have an adjustable mechanism, but on many standard office chairs, the lumbar support is not adjustable.

Many people end up using conference room chairs because they’re more comfortable than their current chair; however, these chairs do not usually have adjustable arms, good lumbar back support, or the waterfall feature for the legs. Having adjustable arms is important—they will give you the option of keeping your arms low if you need to get closer to your work surface. You’ll also be able to adjust them so that your elbows, forearms, and wrists can be positioned at approximately 90°, parallel with the floor.

Your chair should have a waterfall feature and side contours in the seat. The waterfall feature of the chair will allow better blood flow through your legs. By increasing your blood flow, you will help reduce leg discomfort and tiredness.

Your feet should be supported. When your feet are hanging, tucked under your chair, or you’re sitting on them, they often fall asleep. This is bad for your general circulation and the blood supply to your feet. Using an adjustable footrest will not only give your feet support but also a little bit of exercise. Your feet do not have to always be on the footrest; they can be up against it as well, which will still help give you some support.

All of these points are important in selecting the correct ergonomic chair for you. Your chair should have a 5 pedestal or caster base, it should be height adjustable, it should have good lumbar support, an adjustable arm rest, and your seat should still feel comfortable after two hours. You should go out to an office supply store and check out all the different ergonomic office chairs to see which one feels best for you.

Loss of balance, strength, and overall function associated with advancing age are often met with anxiety, fear, and depression. Many of my patients express these feelings to me. It is often assumed advancing age is the problem. Be careful of making that assumption! In most cases it is incorrect.

Although it’s true that loss of muscle strength is associated with advancing age, it’s also true that the ability to restore and improve strength does not diminish with age. In fact, the older and weaker a person is when they begin a strengthening program, the faster they improve. This seems hard to believe, but amazingly it’s true.

Losses in function occur more from inactivity than age. Sadly, most exercisers are young people. It seems our performance-oriented culture views exercise as a competitive venture rather than a way of maintaining health and function. Strengthening exercises carried out properly by avoiding pain and excess fatigue do wonders for balance and overall function.

If you are interested in an in-depth discussion of this topic, check out this great article titled “Exercise and Physical Activity for Older Adults” in the journal Medicine & Science in Sports & Exercise, Volume 30, Number 6, June 1998. If you have trouble locating this article, please stop by my office and I will share a copy with you.

It’s a challenge to engage in all of the components of a Balanced Exercise Program. Lack of time is the main reason we don’t do what is necessary to improve our strength, endurance, balance, and flexibility.

One way to exercise more efficiently is to exercise outdoors instead of in the gym. Why? Because when we exercise outside, we do more than one type of exercise at a time. Without necessarily knowing it, when we exercise outside, we improve our balance along with our endurance and strength.

The reason is that exercises like walking on uneven ground, jogging on the sidewalk, riding a bike, and cross-country skiing improve balance more than riding a stationary bike or walking on a treadmill. Sitting while exercising on a weight machine improves strength, but it does nothing to improve balance. Hiking up and down hills improves both strength and balance.

My wife and I live in a condo where a lot of people exercise in a gym on cardio equipment. On sunny days, I am sometimes tempted to interrupt exercisers and suggest they go outside and enjoy the benefits of two types of exercise for the same amount of time, while enjoying some sunshine all the while.

Gyms are good when the weather is bad, but here in northern California, that is not often the case. Plus, exercise outside is more fun.