I work with many geriatric clientele, and to a person they are all concerned with their balance. Some have gotten so used to their walkers that when they do walk at all, it is frightening to be more than arms length away from their walker. If ones balance is poor, you tend not to move around as much, which results in swelling ankles and legs, and that tends to make matters even worse.

When you have balance, it’s hard to imagine not having balance. But losing it is just  around the corner unless you keep training and challenging your balance skills. Most experts agree that balance ability begins to decline in your 30’s, and it’s loss is very insidious, creeping up on you before you realize it. I’ve done a lot of work with balance training, and there are a few areas that deserve special attention for regaining or preserving it.

Starting with the feet; ankle strength and flexibility are vital. If you lose your balance and it’s a small perturbation, the ankles are the first place to regain it. Do foot circles, point and flex exercises, heel and toe raises are a good place to start.  One can also sway back and forth and side to side to challenge your center-of-gravity (COG). There are various wobble boards, bosu and physioballs, foam rollers, and mini trampolines for more advanced exercises. Balancing on one leg with your arms crossed is a good beginner exercise-you can add closing your eyes to simulate darkness. You can also brush your teeth, comb your hair, etc. while standing on one leg. These are good exercises, but don’t stop there-you need to do balance work while on the move, since most people don’t fall when they are standing still, unless they are pushed by someone. We need to include hip work.

If you encounter a large perturbation or are moving when you lose your balance, you need to use your hips and ankles to regain it. Hip strength and flexibility are key components. Also vital is muscle strength in the upper legs. All of the muscles involved in walking connect to the hips. What I see in my practice is very weak, short and tight hip muscles, which can make it extremely difficult to regain your balance. Hip abduction, flexion, and extension exercises are vital, as well as stretching the hip flexors and external rotators. Stepping off a curb or stair and holding the landing is good practice. Another is taking a few steps and stopping on one leg, then take a few more steps and stop on the other. You can also side step or turn and step. More advanced exercises involve using your arms in various positions, overhead, to the side, using a weight, etc. You can also go down to the hardware store and buy an 8′ 2×4 or 4×4 and walk forward, back, and sideways on it. One of my personal favorites is walking through a hopscotch game. I cut out eight pieces of fabric, 6″x6″, and have the person walk through forward and backward. What once was so easy to do when we were young is very challenging indeed when we get older.

 Use your head. Ear or vestibular balance is also challenging. Certain medications, ear wax, hearing issues can have a big impact on balance. You can do any of the above exercises and turn your head to make them more difficult. Closing your eyes adds great difficulty because we depend so much on sight for balance (It’s called the righting eye reflex).

The great thing about balance exercises is that they can be done anywhere. They requires little cost or equipment, and can be done anytime of day. Use your imagination, you can come up with many more ways to challenge your COG.

PS: Please make sure that when you try these exercises, be close to a counter or some sturdy furniture in case you need to stabilize. Have fun with it.

Stay well, John R Blilie, M.S.